Specialist, Billing

Ovation Healthcare

4d•Remote

About The Position

The Billing Specialist, known as Revenue Cycle Specialist II with ruralMED, is responsible for planning, organizing, and implementing activities related to charging, billing, collections, and cash management functions. This role requires strong, hands-on experience with critical access hospital (CAH), rural health clinic (RHC), and/or hospital/facility billing, including a deep understanding of the unique reimbursement methodologies, regulatory requirements, and payer guidelines associated with these settings. The specialist ensures maximum reimbursement for services provided by utilizing expert knowledge of insurance rules and regulations, best practice workflows, and multiple billing systems. Additionally, this role serves as a key resource and mentor to other billing staff, particularly in complex hospital and rural billing scenarios. Compliance with all applicable federal, state, and local laws, as well as Ovation policies, is required.

Requirements

High School Diploma required
Minimum of 2 years of medical billing experience required
Strong emphasis on hospital/facility billing – required
Proven experience working with facility-based claims, UB-04 billing, and payer reimbursement methodologies
Strong knowledge of medical and insurance terminology
Proficiency with Microsoft Office

Nice To Haves

Associate’s or Bachelor’s degree preferred
5+ years of medical billing experience preferred
Critical Access Hospital (CAH) billing – strongly preferred
Rural Health Clinic (RHC) billing – preferred
Knowledge of Nebraska payer rules is a plus

Responsibilities

Evaluate, coordinate, develop, and implement billing processes, with a strong focus on critical access hospital, RHC, and facility-based billing workflows
Process electronic and paper claims accurately and timely, ensuring compliance with CAH reimbursement methodologies and payer-specific billing requirements
Resolve clearinghouse and DDE claim errors and payer rejections, including those specific to hospital and rural facility billing
Perform follow-up on underpaid or unpaid claims, particularly those involving complex hospital billing structures, cost-based reimbursement, and rural payer nuances
Research and resolve issues impacting reimbursement, including medical necessity, coding discrepancies, and facility-specific billing requirements
Review balances post-insurance to ensure proper adjudication based on hospital and CAH billing guidelines
Resolve overpayments, including reconciliation of facility claims and cost-based reimbursements
Process payer correspondence and take appropriate action using internal and external resources
Maintain aging reports and proactively address accounts nearing timely filing limits
Resolve denied claims using payer reconsideration and appeals processes, with emphasis on facility and rural claim denials
Document all account activity thoroughly within the EHR system
Review and act on accounts receivable reports (DNFB, ATB, denials, clean claims, etc.), with attention to hospital billing performance metrics
Prepare reports to address payer discrepancies, particularly those involving facility reimbursement issues
Maintain accurate payer setup, including rules specific to hospital, CAH, and rural billing
Stay current on CMS, Medicaid, and commercial payer regulations impacting facility and rural reimbursement
Perform reimbursement analysis, including cost-based reimbursement and hospital payment methodologies
Monitor third-party payer contracts to ensure accurate reimbursement
Maintain proficiency in EHR, clearinghouse, and payer systems
Communicate escalated billing or payer issues to leadership
Participate in meetings, training, and continuing education
Maintain professionalism and confidentiality at all times