Offer summary

Qualifications:

High school diploma or equivalent, with additional training in hospital insurance collections preferred., 3-5 years of experience in hospital accounts receivable or collections., Knowledge of medical terminology, ICD-10, CPT, and DRG is advantageous., Proficiency in Excel and experience working independently in a remote environment..

Key responsibilities:

Follow up with insurance payers on outstanding claims to ensure payment.

Document and analyze account information using established policies and workflow tools.

Write appeals to overturn claim denials and escalate unresolved issues to management.

Maintain productivity and quality standards while managing assigned accounts.

Job description

Welcome to Ovation Healthcare!

At Ovation Healthcare, 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 https://ovationhc.com.

Summary:

The primary responsibility of this position is to follow-up with insurance payers on outstanding claims, break down obstacles to payment, and accelerate cash collections.

Duties and Responsibilities:

Responsible for follow-up and collecting on accounts in assigned inventory. Utilizes experience and follow-up strategies and tools to resolve claims and obtain payment.
Escalates unpaid claims to payer claims supervisor as appropriate when regular follow-up efforts are not successful.
Documents client’s host system utilizing the 5 W’s framework and related policies/procedures to ensure accurate and complete documentation and then copies account notes into Amplify’s workflow tool.
Assigns appropriate status codes (e.g. root cause, action, etc.) in Amplify’s workflow tool so trends can be identified and addressed.
Writes first and second level appeals of all denials in effort to overturn and secure payment.
Escalates payer denial and other trends to Management for further assistance.
May also work assigned underpayments as assigned by Management.
Maintains client and/or position specific daily productivity and quality expectations.
Researches and analyzes any correspondence received related to assigned accounts.

Knowledge, Skills, and Abilities:

Must adapt and demonstrate the ability to work independently from home in a fast-paced,
changing and goal-oriented environment.
Direct account follow-up and/or billing experience.
Medical Terminology, ICD-10, CPT and DRG knowledge a preferred, knowledge of third-party Intermediate experience in Excel preferred.
Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence.
Demonstrates understanding of the entire revenue cycle.
Must be detail oriented, organized, and possess the ability to apply critical thinking skills.
Assists with problem solving, inquiries, and customer interaction to ensure positive results.

Work Experience, Education, and Certifications:

High school diploma or equivalent; additional training in hospital insurance collections is a plus. 3-5 years of collections experience in a Hospital Business Office.

Working Conditions and Physical Requirements:

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 should be maintained to reduce eye strain.