Find & Apply For Claims Specialist / Adjuster / Examiner Jobs in Welcome, South Carolina

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.

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

Electronic Denials:

Correct/Resubmit claims in the clearinghouse portal and in the billing system. Direct rejected claims to other departments for resolution if warranted. Identify denial trends and report to lead for review to assist in preventing future denials. Open cases and work directly with the clearinghouse when claim rejections are being received in error.

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 claim 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 Reliable high-speed internet connection is required for all remote/hybrid positions. Must have access to stable Wi-Fi with sufficient bandwidth to support video conferencing, cloud-based tools, and other online work-related activities. A HIPAA-compliant work environment is required, including a secure workspace free from unauthorized access or interruptions, no use of public Wi-Fi unless connected through a secure company-provided VPN, and compliance with all applicable HIPAA privacy and security regulations. 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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