Specialist, Billing

QHR Health, LLC dba Ovation Healthcare; United States; Remote; USD 45,000 - 68,000; Full time

Benefits offered by this job

Health insurance

401(k) plan

Paid time off

Professional development

Job summary

Ovation Healthcare seeks a Specialist, Billing to manage daily billing, ensure clean claims, and resolve edits in line with CMS/HIPAA policies. You’ll handle payer guidelines, portal uploads, and collaborate with the team to optimize cash flow.

The role supports remote work from home with a stable internet connection, requiring 3–5 years in hospital billing, knowledge of UB/1500 guidelines, ICD-10/CPT, and strong communication to resolve payer and patient inquiries.

Qualifications

• Experience in third party insurance billing, collections, or patient accounts in healthcare.
• Knowledge of billing codes, guidelines, and regulations.
• Familiarity with EHR systems and billing software.

Responsibilities

• Manage daily billing and ensure timely, accurate clean claims.
• Review and resolve claim edits and CMS/HIPAA compliance issues.
• Coordinate with patient financial services and other teams to reduce AR days.
• Ensure proper documentation and posting of payments and remittances.

Skills

Third party billing experience

Billing and collections

HIPAA compliance

Strong communication

Detail-oriented

Education

High school diploma or equivalent

Medical billing training

Tools

EHR systems

Billing software

Remittance processing

Job description

About the Job 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 Specialist, Billing is responsible for managing the daily billing and ensuring timely accurate clean claims, claim reviews and resolves billing daily claim edits and ensuring compliance with Insurance billing policies and regulations.

Duties and Responsibilities

• Extensive understanding of billing guidelines for UB/1500 claims and a deep understanding of each claim field requirement.
• Maintain a list of split billing requirements by payer and add to the team crosswalk and keep abreast of any payer changes.
• The billing specialist should be well versed in Payer portal appeal uploads and assist with providing the internal team feedback when necessary.
• Import claims from host system into claims processing system when required.
• Review claims that are pended for edits and resolve.
• Prepare and submit accurate claims for patient services, ensuring compliance with third party payer guidelines and regulations.
• Review patient accounts and reconcile payments with secondary payers and review remittance advice, ensuring all payments are posted correctly and outstanding balances are addressed before filing the secondary payer.
• Ensure all billing and collection practices are compliant with CMS regulations, HIPAA, and company policies.
• Maintain accurate records of all claims and ensure proper documentation in the patient account system.
• Meet daily productivity and quality standards as assigned.
• Work with internal departments, such as patient financial services, finance, and billing, to address any issues or disputes affecting patient accounts.
• Assist management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows.

Knowledge, Skills, and Abilities

• Proven experience in third party insurance billing, collections, or patient accounts, preferably in a healthcare setting.
• In-depth knowledge of billing codes, guidelines, and regulations.
• Familiarity with electronic health record (EHR) systems, billing software, and remittance advice processing.
• Strong communication skills, with the ability to explain Medicare billing details and resolve patient concerns effectively.
• Ability to handle sensitive information and maintain confidentiality in accordance with HIPAA regulations.
• Detail-oriented with strong organizational skills and the ability to manage multiple accounts simultaneously.
• Problem-solving abilities, particularly regarding billing discrepancies and denied claims.

Work Experience, Education and Certificates

Experience utilizing Payer portals, client systems and clearing house requirements 3-5 years of experience as a primary biller in hospital Business Office. Medical Terminology, ICD-10, CPT and DRG knowledge a preferred, knowledge of third-party Insurance payer guidelines High school diploma or equivalent; additional training in medical billing is a plus.

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.

Travel Requirements

None

Benefits

The base compensation range for this position is: $45,094.28 - $67,641.42 Compensation ranges could be hourly or salary depending upon the exempt status of the posted position.

Beginning compensation is determined based on objective factors such as location, qualifications, skills, certifications, and experience. Typically, a candidate is hired in the lower to midpoint of the range; the top end of the range is reserved for candidates with extensive specialized experience and mastery within the role. Compensation may increase over time based on performance, experience, and tenure. Compensation is only part of Ovation's total compensation package.

Some additional benefits offered to full-time associates are:

• Comprehensive health and wellness benefits such as medical, dental, vision, life insurance, short and long-term disability coverage
• HSA with employer contributions, flexible spending accounts for health care, and dependent care accounts
• Wellness platform with premium incentives
• Employee assistance support and additional voluntary supplemental plans including accident, critical illness, hospital indemnity, and child disability insurance
• Robust and flexible paid time off offerings and company paid holidays
• 401(k) plan with discretionary employer match opportunities
• Professional development opportunities
• Company issued equipment

Ovation will never contact applicants via Chatwork or any other messaging platform outside of our official channels. If you receive any communication claiming to be from Ovation through Chatwork or any unauthorized platform, please disregard it and report it to us immediately. Our official communication will always come from our company email domain or through recognized professional channels like LinkedIn. If you have any questions or concerns regarding the authenticity of a communication, please contact us directly at [e-mail] for verification.

Headquartered in Brentwood, Tenn., Ovation Healthcare partners with 375+ hospitals and health systems across 47 states. For 45+ years, Ovation Healthcare has supported hospitals and health systems through a portfolio of shared services – Leadership Advisory, Spend Management, Revenue Cycle Management, and Technology Services– designed to provide scale and efficiency to hospital business operations.