Specialist, Billing

Ovation Healthcare

5d•$46,667 - $65,333•Remote

About The Position

The Billing Specialist, known as Revenue Cycle Specialist II with ruralMED, plans, organizes, and implements activities related to charging, billing, collections, and cash management. The role focuses on critical access hospital (CAH), rural health clinic (RHC), and hospital/facility billing, including the reimbursement methodologies, regulatory requirements, and payer guidelines relevant to these settings. The specialist uses knowledge of insurance rules, best-practice workflows, and multiple billing systems to support maximum reimbursement and serves as a resource and mentor to other billing staff, particularly on complex hospital and rural billing scenarios. The role requires compliance with applicable federal, state, and local laws and Ovation policies. This position is expected to be remote 100% of the time unless otherwise agreed upon. The employee must have a stable internet connection, a dedicated workspace, and necessary equipment. The role involves prolonged sitting and regular communication by phone, email, and video conferencing, as well as access to confidential information and compliance with privacy and security policies.

Requirements

High school diploma required.
At least 2 years of medical billing experience required.
Hospital/facility billing experience required.
Experience with facility-based claims, UB-04 billing, and payer reimbursement methodologies.
Knowledge of medical and insurance terminology.
Proficiency with Microsoft Office.
Ability to work remotely with a stable internet connection, a dedicated workspace, and access to necessary equipment.
Ability to comply with privacy and security policies when accessing confidential information.

Nice To Haves

Associate’s or bachelor’s degree preferred.
Five or more years of medical billing experience preferred.
Critical Access Hospital (CAH) billing experience strongly preferred.
Rural Health Clinic (RHC) billing experience preferred.
Knowledge of Nebraska payer rules is a plus.

Responsibilities

Evaluate, coordinate, develop, and implement billing processes, with a focus on CAH, RHC, and facility-based workflows.
Process electronic and paper claims accurately and promptly in compliance with CAH reimbursement methodologies and payer-specific requirements.
Resolve clearinghouse and DDE claim errors and payer rejections, including those related to hospital and rural facility billing.
Follow up on underpaid or unpaid claims, including claims involving complex hospital billing structures, cost-based reimbursement, and rural payer requirements.
Research and resolve reimbursement issues, including medical necessity, coding discrepancies, and facility-specific billing requirements.
Review post-insurance balances to ensure proper adjudication under 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 approaching timely filing limits.
Resolve denied claims through payer reconsideration and appeals processes, particularly for facility and rural claims.
Document account activity thoroughly in the EHR system.
Review and act on accounts receivable reports, including DNFB, ATB, denials, and clean claims, with attention to hospital billing performance metrics.
Prepare reports addressing payer discrepancies, particularly 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 affecting facility and rural reimbursement.
Perform reimbursement analysis, including cost-based reimbursement and hospital payment methodologies.
Monitor third-party payer contracts to support 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.

Benefits

Medical, dental, vision, and life insurance
Short- and long-term disability coverage
HSA with employer contributions
Flexible spending accounts for health care and dependent care
Wellness platform with premium incentives
Employee assistance support
Voluntary supplemental plans, including accident, critical illness, hospital indemnity, and child disability insurance
Flexible paid time off
Company-paid holidays
401(k) plan with discretionary employer match opportunities
Professional development opportunities
Company-issued equipment