Job description

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 www.ovationhc.com

The primary responsibility for this position is to provide resolution on accounts referred with denials needed appealing or other follow-up. Researches and analyzes denials on a daily basis, identifies root causes, and processes resubmissions/appeals with the goal of overturning the denial and getting paid by the insurance carrier, maximizing revenue for our clients.

Reports to: VP of Shared Services

Department: Operations

Essential Functions

· The Denials Management Analyst is responsible for analyzing denials data, creating metrics, as well as tracking and trending denials and results.

· The Denials Management Analyst will identify and trend root causes and report out findings as well as assist in mapping out process improvement opportunities.

· Ensures identification and resolution of all claims referred and assist in refining future referrals. Responsible for technical and clinical denials.

· Includes clinical resources when appropriate and monitors performance of clinical appeals.

· The person in this position will coordinator payor denials and audit activities to ensure timely response for the processing of all payor denials, audit requests and appeals.

· The ideal candidate will communicate and coordinate with various individuals / distributions and assist with monitoring of the day-to-day activities related to claims denials and audit reviews.

· Collecting/analyzing, report status, metrics and trends of activity and provide education. Reporting to be provided to necessary parties on a normal cadence.

· Assisting with the coordination of denial and review activities and materials for committee meetings, including all necessary reporting.

· Supporting projects and initiatives of the Denials Management Team, to include coordinating meetings, conducting research, performing audits or data analysis, and preparing documents.

· Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

· Provides precise documentation of all actions taken on accounts worked.

· Maintains client and/or position specific daily productivity and quality expectations.

Required Skills and Experience

· Healthcare background is required, preferred to have knowledge in revenue cycle.

· The ability to work in a fast-paced environment balancing multiple priorities and utilizing resources.

· Requires the ability to interpret all aspects of a contract with an emphasis on the implementation and operational components of contract terms.

· Must be a self-starter with the ability to identify, understand and research issues specific to payor contracts. This may require working with the development team on new functionality to be added if new reimbursement is introduced that is not currently available in our system.

· MS Office Tools

· Excellent interpersonal skills are necessary to develop strong working relationships with internal and external contact.

• Experience with various electronic medical records and understand HIPAA and PHI privacy and security.
• A team player, always willing to contribute to the whole of the organization.

· Must be able to pass as skills assessment exam, comprehensive and background check.

Preferred Skills and Experience

• Ability to function in a high intensity environment and can adapt to change in the work environment.
• Exhibits effective and independent decision-making skills and can follow oral and written instruction or direction.
• Strong professional written and verbal communication skills.
• Knowledge of VPNs and remote desktops.
• Proficient use of computers and general office-type equipment.
• Hospital revenue cycle: 5+ years (including billing and appeals)

Education

• GED/High School Diploma
• Bachelors Degree Preferred

Work Environment – Mental/Physical Activities

· Requires prolonged sitting, some bending, stooping, and stretching

· High level of manual dexterity sufficient to perform the essential functions of the position as the ability to operate a computer keyboard, photocopier, telephone, calculator, and other office equipment

· Ability to read numbers, reports, and computer terminals

· Ability to use the telephone and communicate to others in an efficient manner

· Ability to give, receive and analyze information

· Ability to formulate work plans and follow through to completion

· Ability to solve problems inherent to the position and analytical skills to assess situations

· Ability to conceptualize, plan, organize and communicate concepts

· Ability to remain distraction free for 8 hours while working remotely

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Chicago, IL: Reliably commute or planning to relocate before starting work (Preferred)

Work Location: In person

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