Specialist, Billing
New
O
Ovation HealthcareMedical Billing
United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- Minimum of 2 years of medical billing experience required (5+ years preferred)
- Required Skills
- Microsoft Office
Requirements
- High School Diploma required; Associate’s or Bachelor’s degree preferred.
- Minimum of 2 years of medical billing experience required, 5+ years preferred.
- Strong experience with hospital/facility billing is required.
- Experience with Critical Access Hospital (CAH) billing is strongly preferred.
- Experience with Rural Health Clinic (RHC) billing is preferred.
- Proven knowledge of facility-based claims, UB-04 billing, and payer reimbursement methodologies.
- Strong knowledge of medical and insurance terminology.
- Proficiency with Microsoft Office.
- Ability to work remotely with a stable internet connection and dedicated workspace.
Responsibilities
- Evaluate, coordinate, develop, and implement billing processes focused on critical access hospital, RHC, and facility-based workflows.
- Process electronic and paper claims while ensuring compliance with reimbursement methodologies and payer requirements.
- Resolve clearinghouse and DDE claim errors and manage payer rejections.
- Perform follow-up on underpaid or unpaid claims involving complex hospital structures and cost-based reimbursement.
- Research and resolve issues impacting reimbursement such as medical necessity and coding discrepancies.
- Review balances post-insurance to ensure proper adjudication based on hospital and CAH billing guidelines.
- Maintain aging reports and address accounts nearing timely filing limits.
- Prepare reports to address payer discrepancies and monitor performance metrics.
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