Qureos Mentor

Ovation Healthcare

<div><div>General Requirements/Job Duties:</div><div>
To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed below are representative of the knowledge, skill, and / or ability required:</div><div></div><div>
Billing:</div><ul><li><div>
Responsible for the evaluation, coordination, development and implementation of billing and related processes.</div></li><li><div>
Processes electronic and paper claims in a timely and accurate manner. Ensures edits to electronic claims meet and satisfy billing compliance guidelines for electronic submission.</div></li><li><div>
Resolves clearinghouse and DDE claim errors and payer rejections.</div></li><li><div>
Performs follow-up processes on underpaid or unpaid insurance claims. Researches, identifies and rectifies any circumstances affecting delayed payment of accounts and takes steps to get claim paid utilizing websites, phone calls to the payers, and/or internal inquiry.</div></li><li><div>
Resolves issues holding up timely claim payment, including requests for medical records, coordination of benefit issues, and request for more information, by coordinating with the responsible department.</div></li><li><div>
Reviews remaining balances on accounts after insurance has paid to ensure the account was processed appropriately and performs the next appropriate action.</div></li><li><div>
Resolves overpaid accounts by performing payment review to determine if posting corrections are required or/and a refund is due to the insurance company.</div></li><li><div>
Processes incoming correspondence from insurance companies, and performs proper action utilizing internal and external resources.</div></li><li><div>
Maintains an account aging process for tracking accounts approaching 30 days past billing date.</div></li><li><div>
Processes adjustments or corrections to patient account(s) according to policy guidelines.</div></li><li><div>
Resolve denied claims utilizing the payer&rsquo;s designated reconsideration and appeal process.</div></li><li><div>
Receives and resolves inquiries regarding accounts, either in-person, by phone or written correspondence from patients, family members, third-party payers, physicians, etc.</div></li><li><div>
Accurately and thoroughly documents all actions performed on an account in the appropriate area of the EHR system.</div></li></ul><div></div><div>
Credentialing:</div><ul><li><div>
Performs initial insurance credentialing and re-credentialing activities for facilities and individual providers.</div></li><li><div>
Compiles and maintains current and accurate data for all providers and facilities required to complete insurance credentialing.</div></li><li><div>
Ensures data in CAQH is completed and kept up to date.</div></li></ul><div></div><div>
Mentorship:</div><ul><li><div>
Assists staff in troubleshooting problems / issues, including assistance in monitoring their daily activities.</div></li><li><div>
Mentors staff on an individual basis to evaluate work tasks / processes and assists staff in developing efficient and effective processes.</div></li><li><div>
Maintains advanced knowledge of systems and billing requirements. Serves as an educational resource to educate staff.</div></li><li><div>
Develops workflows and step by step documentation to assist in the training of staff.</div></li></ul><div></div><div>
Reporting:</div><ul><li><div>
Reviews and acts on accounts receivable maintenance reporting. Such as reporting on DNFB, claim edits, ATB, denials, clean claims, etc.</div></li><li><div>
Prepares reports to share with payers when discrepancies in reimbursement are uncovered.</div></li></ul><div></div><div>
Other:</div><ul><li><div>
Maintains and reviews proper payer setup including but not limited to payer address, payer product lines, timely filing guidelines, submission schedules, ANSI codes and fee schedules</div></li><li><div>
Maintains current knowledge of billing and reimbursement rules as designated by the Centers of Medicare and Medicaid Services (CMS), Medicaid Managed Care, and other payers. Communicates all changes to applicable staff/departments/facilities.</div></li><li><div>
Maintains advanced reimbursement knowledge and performs reimbursement analysis as necessary. Monitors third-party contract payment arrangements, both private and governmental to ensure accurate reimbursement.</div></li><li><div>
Keeps up to date with regulations that affect collection of receivables; monitors third-party contract payment arrangements, both private and governmental.</div></li><li><div>
Maintains proficient knowledge of EHR, clearinghouse, and payer systems, as well as any other systems, required for performing required job duties.</div></li><li><div>
Communicates issues to management, including payer, system, or escalated account issues.</div></li><li><div>
Maintains proficient knowledge of EHR, clearinghouse, and payer systems, as well as any other systems, required for performing required job duties.</div></li><li><div>
Participates in department meetings, in-service programs, and continuing education programs.</div></li><li><div>
Maintains a professional attitude with patients, visitors, physicians, office staff and hospital personnel. Assures confidentiality of patient and hospital information, maintaining compliance with policies and procedures.</div></li><li><div>
Other duties as assigned.</div></li><li><div>
Demonstrates competency annually in assigned areas of work.</div></li></ul></div>

Specialist, Billing

<div><div>Welcome to Ovation Healthcare!</div><div></div><div>
At Ovation Healthcare, we&rsquo;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.</div><div></div><div>
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.</div><div></div><div>
We&rsquo;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.</div><div>
Ovation Healthcare's corporate headquarters is located in Brentwood, TN. For more information, visit <div>https://ovationhc.com</div>.</div><div></div><div>
Summary</div><div>
Leads planning, execution governance, risk management, and stakeholder reporting for the Vulnerability, Patching, and Hardening program. Ensures engineering teams deliver remediation work on schedule, within approved change windows, with complete documentation, evidence, and service level agreement aligned reporting.</div><div></div><div>
Essential functions</div><ul><li><div>
Build and manage the integrated program plan and rolling schedule for vulnerability remediation, patching, and hardening across all towers.</div></li><li><div>
Run execution governance including readiness reviews, weekly stakeholder cadence, change scheduling discipline, and post-implementation reviews.</div></li><li><div>
Maintain the risk, action, issue, and decision log and drive timely escalation and decision closure.</div></li><li><div>
Coordinate dependencies across Security, Service Desk, Service Management, application owners, infrastructure teams, and client stakeholders.</div></li><li><div>
Partner with delivery leads to ensure Qualys Vulnerability Management findings are translated into actionable remediation waves and validated closure reporting.</div></li><li><div>
Publish executive-ready status reporting including schedule performance, risks, remediation progress, vulnerability aging, compliance trends, and service level agreement attainment.</div></li><li><div>
Ensure documentation quality including runbooks, implementation plans, communications templates, and evidence packages for audit and compliance needs.</div></li><li><div>
Support resource planning, capacity forecasting, and surge planning during high severity vulnerability events.</div></li></ul><div></div><div>
Required Qualifications</div><ul><li><div>
Five or more years of project management experience leading infrastructure operations, remediation, endpoint, server, or network delivery programs.</div></li><li><div>
Demonstrated experience managing programs that require after-hours change windows, formal change governance, and measurable operational outcomes.</div></li><li><div>
Strong command of metrics and reporting, including service level agreement tracking and executive-level status communications.</div></li><li><div>
Working knowledge of vulnerability management concepts and tool-assisted validation, including Qualys Vulnerability Management.</div></li></ul><div></div><div>
Preferred Qualifications</div><ul><li><div>
Hospital information technology experience strongly preferred; broader healthcare experience preferred.</div></li><li><div>
Certifications highly desirable: Project Management Professional, Certified ScrumMaster, ITIL Foundation, or equivalent.</div></li></ul><div></div><div>
Work Schedule Expectations</div><ul><li><div>
Flexibility to support governance and communications surrounding after-hours maintenance activities.</div></li></ul><div></div><div>
Working Conditions and Physical Requirements:</div><ul><li><div>
Reliable high-speed internet connection is required for all remote/hybrid positions.</div></li><li><div>
Must have access to stable Wi-Fi with sufficient bandwidth to support video conferencing, cloud-based tools, and other online work-related activities.</div></li><li><div>
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.</div></li></ul><div></div><div>
#LI-Hybrid</div></div><div></div>

Project Manager

Join Ovation Healthcare and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Ovation Healthcare

About Company

Specialist, Billing

Project Manager