Specialist, Follow Up

QHR Health, LLC dba Ovation Healthcare; United States; Remote; USD 42,000 - 64,000; Full time

Job summary

Ovation Healthcare is seeking a Follow Up Specialist to manage electronic denials, paper denials and unpaid claims, resolving denied or unpaid claims with carriers. The role involves forwarding denials to other departments, using portals, calls, and emails, and appealing when needed.

Remote 100%, home office, ability to multitask and adapt to changing regulations; requires 1-2 years AR Follow-Up, CMS 1500 Billing knowledge, and strong communication skills.

Qualifications

• 1-2 years of AR Follow-Up experience.
• Experience with CMS 1500 Billing and multiple clearinghouses.
• Knowledge of payer policies and claim denial processes.
• Strong problem-solving and communication skills.

Responsibilities

• Review denied claims for correction or resubmission.
• Follow up on unpaid claims with carriers via calls, portals, and email.
• Identify denial trends and report to team lead.
• Process appeals on denied claims.

Skills

Medical Billing

Denials Management

Aging AR Tracking

Payer Communications

Microsoft Office

Communication Skills

Tools

CMS 1500 Billing

Clearinghouses

EMR Systems

Billing Software

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.

GENERAL SUMMARY:

Follow Up Specialist will work on electronic denial, paper denials and unpaid claims reports to resolve any claims that are denied or unpaid by all insurance carriers. The Specialist will be responsible for forwarding denials to other departments throughout the company so the claims can be handled properly. The Follow Up Specialist will utilize several resources to resolve unpaid claims by online portals, contact via telephone, corresponding via email and appealing claims when needed.

DUTIES AND RESPONSIBILITIES:

Denials:

• Review denied claims for correction/resubmission.

• Direct denied claims to other departments when warranted.

• Utilize multiple online websites and portals for payers to research denied claims.

• Identify denial trends and report to lead for review to assist in preventing future denials.

Aging AR Over 60:

• Follow up on unpaid claims with insurance carriers after a specified claim age.

• Contact insurance companies via telephone, portals, and email requests to inquire on claims denied in error or on claims where there is further information needed to resolve for payment.

• Utilize multiple online websites and portals to research claims.

• Identify denial trends and other issues with insurance carriers and report to lead for review to assist in preventing future denials.

• Process appeals on denied claims.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Basic Medical Billing Knowledge.

• Basic Health Insurance Carrier billing & reimbursement policies.

• Problem solving & dispute resolution.

• Ability to multitask and adapt to changing regulations.

• Strong verbal and written communication skills.

• Excellent organizational and time-management abilities.

• Proficiency in using all Microsoft Office apps such as Teams, Outlook, and Excel.

• Ability to handle multiple tasks and prioritize effectively.

• High attention to detail and problem-solving skills.

WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS:

• 1-2 years’ experience in an AR Follow-Up

• Experience in Professional CMS 1500 Billing, Multiple Clearinghouses, Billing Systems, EMR’s

• Knowledge of Multiple States Billing Requirements, Commercial and Government Payers

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:

• 100% Remote

• Expected to work from a designated home office or other quiet and secure location, free from distractions.

• Access to a suitable workspace that includes reliable internet access.

• Ability to sit for long periods while working at a desk or computer.

• Regular use of a keyboard, mouse, and other computer peripherals.

• Occasional video conferencing, which may involve sitting or standing for meetings.

TRAVEL REQUIREMENTS :

• 0%