Welcome to Ovation Healthcare!
At Ovation Healthcare (formerly QHR Health), we’ve 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 Healthcare’s 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.
We’re 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 Healthcare’s corporate headquarters is located in Brentwood, TN. For more information, visit www.ovationhc.com.
Summary:
The Billing Specialist, known as Revenue Cycle Specialist II with ruralMED, will be responsible for planning, organizing and implementing the activities of charging, billing, collections and cash management functions. They will ensure maximum reimbursement for services provided by utilizing sound knowledge of insurance rules and regulations, best practice workflows, and the use of multiple software systems. Furthermore, with their advanced billing knowledge they will act as resource and mentor to other billing staff. Compliance with rules and regulations of all applicable federal, state and local laws as well as Ovation policies is a condition of employment.
General Requirements/Job Duties:
To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed below are representative of the knowledge, skill, and / or ability required:
Billing:
Responsible for the evaluation, coordination, development and implementation of billing and related processes.
Processes electronic and paper claims in a timely and accurate manner. Ensures edits to electronic claims meet and satisfy billing compliance guidelines for electronic submission.
Resolves clearinghouse and DDE claim errors and payer rejections.
Performs follow-up processes on underpaid or unpaid insurance claims. Researches, identifies and rectifies any circumstances affecting delayed payment of accounts and takes steps to get claim paid utilizing websites, phone calls to the payers, and/or internal inquiry.
Resolves issues holding up timely claim payment, including requests for medical records, coordination of benefit issues, and request for more information, by coordinating with the responsible department.
Reviews remaining balances on accounts after insurance has paid to ensure the account was processed appropriately and performs the next appropriate action.
Resolves overpaid accounts by performing payment review to determine if posting corrections are required or/and a refund is due to the insurance company.
Processes incoming correspondence from insurance companies, and performs proper action utilizing internal and external resources.
Maintains an account aging process for tracking accounts approaching 30 days past billing date.
Processes adjustments or corrections to patient account(s) according to policy guidelines.
Resolve denied claims utilizing the payer’s designated reconsideration and appeal process.
Receives and resolves inquiries regarding accounts, either in-person, by phone or written correspondence from patients, family members, third-party payers, physicians, etc.
Accurately and thoroughly documents all actions performed on an account in the appropriate area of the EHR system.
Credentialing:
Performs initial insurance credentialing and re-credentialing activities for facilities and individual providers.
Compiles and maintains current and accurate data for all providers and facilities required to complete insurance credentialing.
Ensures data in CAQH is completed and kept up to date.
Mentorship:
Assists staff in troubleshooting problems / issues, including assistance in monitoring their daily activities.
Mentors staff on an individual basis to evaluate work tasks / processes and assists staff in developing efficient and effective processes.
Maintains advanced knowledge of systems and billing requirements. Serves as an educational resource to educate staff.
Develops workflows and step by step documentation to assist in the training of staff.
Reporting:
Reviews and acts on accounts receivable maintenance reporting. Such as reporting on DNFB, claim edits, ATB, denials, clean claims, etc.
Prepares reports to share with payers when discrepancies in reimbursement are uncovered.
Other:
Maintains and reviews proper payer setup including but not limited to payer address, payer product lines, timely filing guidelines, submission schedules, ANSI codes and fee schedules
Maintains current knowledge of billing and reimbursement rules as designated by the Centers of Medicare and Medicaid Services (CMS), Medicaid Managed Care, and other payers. Communicates all changes to applicable staff/departments/facilities.
Maintains advanced reimbursement knowledge and performs reimbursement analysis as necessary. Monitors third-party contract payment arrangements, both private and governmental to ensure accurate reimbursement.
Keeps up to date with regulations that affect collection of receivables; monitors third-party contract payment arrangements, both private and governmental.
Maintains proficient knowledge of EHR, clearinghouse, and payer systems, as well as any other systems, required for performing required job duties.
Communicates issues to management, including payer, system, or escalated account issues.
Maintains proficient knowledge of EHR, clearinghouse, and payer systems, as well as any other systems, required for performing required job duties.
Participates in department meetings, in-service programs, and continuing education programs.
Maintains a professional attitude with patients, visitors, physicians, office staff and hospital personnel. Assures confidentiality of patient and hospital information, maintaining compliance with policies and procedures.
Other duties as assigned.
Demonstrates competency annually in assigned areas of work.
Qualifications:
Working Conditions:
Work from home and remote location with a stable internet connection, a quiet and dedicated workspace free of distractions, and access to necessary office equipment. The ability to have daily communication with team members, management, and clients through email, phone calls, video meetings and other collaborative tools. Primarily requires sitting at a desk for extended period. Proper lighting and ergonomics shole be maintained to reduce eye strain.
Security/Access:
Remote work is expected 100% of the time unless otherwise agreed upon.
Will have access to confidential information abiding by the organizations privacy policies and regulations concerning this information.