Specialist, Billing

Welcome to Ovation Healthcare!

At Ovation Healthcare (formerly QHR Health) weve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence we help rural healthcare providers fulfill their missions.

The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcares vision is to be a dynamic integrated professional services company delivering innovative and executable solutions through experience and thought leadership while valuing trust respect and customer-focused behavior.

Were looking for talented motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives in a collegial atmosphere of professionalism and teamwork.

Ovation Healthcares corporate headquarters is located in Brentwood TN. For more information visit .

Summary:

The Billing Specialist known as Revenue Cycle Specialist II with ruralMED is responsible for planning organizing and implementing activities related to charging billing collections and cash management functions.

This role requires strong hands-on experience with critical access hospital (CAH) rural health clinic (RHC) and/or hospital/facility billing including a deep understanding of the unique reimbursement methodologies regulatory requirements and payer guidelines associated with these settings.

The specialist ensures maximum reimbursement for services provided by utilizing expert knowledge of insurance rules and regulations best practice workflows and multiple billing systems. Additionally this role serves as a key resource and mentor to other billing staff particularly in complex hospital and rural billing scenarios. Compliance with all applicable federal state and local laws as well as Ovation policies is required.

General Requirements / Job Duties:

To perform this job successfully an individual must be able to perform each essential job duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required.

Billing (Hospital & Rural Focus):

• Evaluate coordinate develop and implement billing processes with a strong focus on critical access hospital RHC and facility-based billing workflows
• Process electronic and paper claims accurately and timely ensuring compliance with CAH reimbursement methodologies and payer-specific billing requirements
• Resolve clearinghouse and DDE claim errors and payer rejections including those specific to hospital and rural facility billing
• Perform follow-up on underpaid or unpaid claims particularly those involving complex hospital billing structures cost-based reimbursement and rural payer nuances
• Research and resolve issues impacting reimbursement including medical necessity coding discrepancies and facility-specific billing requirements
• Review balances post-insurance to ensure proper adjudication based on hospital and CAH billing guidelines
• Resolve overpayments including reconciliation of facility claims and cost-based reimbursements
• Process payer correspondence and take appropriate action using internal and external resources
• Maintain aging reports and proactively address accounts nearing timely filing limits
• Resolve denied claims using payer reconsideration and appeals processes with emphasis on facility and rural claim denials
• Document all account activity thoroughly within the EHR system

Credentialing:

• Perform credentialing and re-credentialing for facilities and providers ensuring alignment with hospital and rural billing requirements
• Maintain accurate provider and facility data for payer enrollment and reimbursement
• Ensure CAQH profiles are complete and current

Mentorship:

• Serve as a subject matter expert in critical access RHC and hospital billing
• Assist staff in troubleshooting complex billing issues especially those related to facility claims and rural reimbursement models
• Mentor team members to improve efficiency and accuracy in billing processes
• Develop workflows and documentation specific to hospital and rural billing best practices

Reporting:

• Review and act on accounts receivable reports (DNFB ATB denials clean claims etc.) with attention to hospital billing performance metrics
• Prepare reports to address payer discrepancies particularly those involving facility reimbursement issues

Other:

• Maintain accurate payer setup including rules specific to hospital CAH and rural billing
• Stay current on CMS Medicaid and commercial payer regulations impacting facility and rural reimbursement
• Perform reimbursement analysis including cost-based reimbursement and hospital payment methodologies
• Monitor third-party payer contracts to ensure accurate reimbursement
• Maintain proficiency in EHR clearinghouse and payer systems
• Communicate escalated billing or payer issues to leadership
• Participate in meetings training and continuing education
• Maintain professionalism and confidentiality at all times

Qualifications:

• High School Diploma required; Associates or Bachelors degree preferred
• Minimum of 2 years of medical billing experience required (5 years preferred) with a strong emphasis on:
  • Critical Access Hospital (CAH) billing strongly preferred
  • Hospital/facility billing required
  • Rural Health Clinic (RHC) billing preferred
• Proven experience working with facility-based claims UB-04 billing and payer reimbursement methodologies
• Strong knowledge of medical and insurance terminology
• Proficiency with Microsoft Office
• Knowledge of Nebraska payer rules is a plus

Working Conditions:

• Work from home with a stable internet connection a dedicated workspace and access to necessary equipment. Requires prolonged sitting and consistent communication via phone email and video conferencing.
• Remote work is expected 100% of the time unless otherwise agreed upon. This role requires access to confidential information and adherence to all privacy and security policies.