Specialist, ProFee Follow Up

About the Company

Ovation Healthcare strengthens independent community healthcare by providing support, guidance, and tech-enabled shared services to independent hospitals and health systems. With over 40 years of experience, we help rural healthcare providers fulfill their missions through operational excellence and innovative solutions. Our vision is to deliver dynamic, integrated professional services that value trust, respect, and customer-focused behavior. Corporate headquarters is located in Brentwood, TN.

About the Role

Follow Up Specialists resolve electronic denials, paper denials, and unpaid claims by working with all insurance carriers. They forward denials to other departments for proper handling and utilize various resources—such as online portals, phone, email, and appeals—to resolve unpaid claims.

Responsibilities

• Correct and resubmit electronic denials in clearinghouse portals and billing systems.
• Direct rejected claims to other departments for resolution when necessary.
• Identify denial trends and report them to leadership to prevent future denials.
• Open cases and work directly with clearinghouses to resolve claim rejections received in error.
• Review denied claims for correction or resubmission and route them to other departments when warranted.
• Research denied claims using multiple online payer portals and websites.
• Follow up on unpaid claims over 60 days old by contacting insurance carriers via phone, portals, or email.
• Process appeals for denied claims.
• Utilize online resources to research claims and identify trends or issues with insurance carriers.

Requirements

• 1-2 years of experience in AR Follow-Up.
• Experience with Professional CMS 1500 Billing, multiple clearinghouses, billing systems, and EMRs.
• Knowledge of multiple states' billing requirements, commercial payers, and government payers.

Skills

• Basic medical billing knowledge.
• Understanding of health insurance carrier billing and reimbursement policies.
• Problem-solving and dispute resolution.
• Ability to multitask and adapt to changing regulations.
• Strong verbal and written communication skills.
• Excellent organizational and time-management abilities.
• Proficiency in Microsoft Office apps (Teams, Outlook, Excel).
• Ability to handle multiple tasks and prioritize effectively.
• High attention to detail and problem-solving skills.

Working Conditions

• 100% remote position.
• Must work from a designated home office or other quiet, secure location free from distractions.
• Requires a suitable workspace with 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%