Specialist, Billing
About this role
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 .
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
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; Associate’s or Bachelor’s degree preferred
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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.
Originally posted on Himalayas