Specialist, Follow Up

QHR Health; United States; Remote; USD 41,000 - 61,000; Full time

Benefits offered by this job

Health benefits

HSA with employer contributions

Wellness platform

Job summary

Ovation Healthcare is seeking a Follow Up Specialist to resolve denied or unpaid claims across various insurers. You will forward denials to relevant teams, utilize payer portals, and appeal as needed. Remote work is supported with a home-office setup.

The role requires 1–2 years in AR follow-up, familiarity with CMS 1500 billing, and strong problem-solving and communication skills. Health benefits are included for full-time staff.

Qualifications

• 1-2 years' experience in 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.

Responsibilities

• Review denied claims for correction/resubmission.
• Direct denied claims to other departments when warranted.
• Research denied claims using payer portals and portals.
• Identify denial trends and report for prevention of future denials.
• Follow up on unpaid claims with insurance carriers after a specified claim age.
• Contact insurance companies to inquire on denied claims or requests for information.
• Process appeals on denied claims.

Skills

Medical Billing basics

Billing policies

Problem solving

Multitasking

Communication skills

Microsoft Office

Education

1-2 years AR follow-up experience

CMS 1500 Billing

Multiple Clearinghouses

Billing Systems

EMR systems

Tools

CMS 1500

Clearinghouses

Billing Systems

EMR

Job description

About the Job

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

• 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.


• 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

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Benefits

The base compensation range for this position is:

$40,994.80 - $61,492.20

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