Specialist, Revenue Recovery

Welcome to Ovation Healthcare!

At Ovation Healthcare (formerly QHR Health), 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 corporateheadquartersis located in Brentwood, TN. For more information, visit.

Summary:

This role is focused on maximizing revenue for our Insource hospital clients by meticulously investigating, analyzing, and resolving technical claim denials and complex contractual underpayments. As a specialist, you will leverage your existing accounts receivable expertise and our advanced technology platform, Health Innovas "Pulse," to uncover hidden revenue opportunities and ensure our clients are reimbursed fully and accurately for the care they provide.

This position offers a unique career development opportunity for high-performing team members to become subject matter experts in the most challenging and rewarding areas of the revenue cycle.

Duties and Responsibilities:

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Denial and Underpayment Analysis:

• Utilize the Health Innovas "Pulse" platform to systematically review client accounts flagged for potential denials or underpayments.

• Conduct deep-dive investigations into technical denials, including those related to eligibility, registration errors, missing authorizations, and other administrative issues.

• Analyze explanation of benefits (EOBs) and compare actual payments against modeled payer contracts to precisely identify and quantify contractual underpayments.

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Resolution and Recovery:

• Correct data errors and resubmit claims in a timely manner to resolve technical denials.

• Prepare detailed documentation and justification to support underpayment appeals and resolution efforts.

• Collaborate with Clinical Appeals Specialists (RNs) and Certified Coders by gathering necessary documentation for complex clinical and coding-related denials.

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Process Improvement and Reporting:

• Diagnose the root cause of each denial and underpayment to identify trends by payer, service line, and denial reason.

• Meticulously document all actions, findings, and communications within the Pulse platform to ensure a clear audit trail and support team collaboration.

• Contribute to performance reports that provide actionable insights to both internal leadership and clients, helping to prevent future revenue leakage.

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Team Collaboration:

• Serve as a key resource for resolving complex payment issues, working alongside Payer Contract

• Specialists and Denial Management leadership.

• Participate in ongoing training to master the Pulse platform and stay current on evolving payer rules and denial trends.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Strong foundational understanding of the healthcare revenue cycle, including claims submission, remittance processing, and follow-up.

• Demonstrated analytical and critical thinking skills with a high level of attention to detail.

• Excellent written and verbal communication skills, with the ability to clearly and concisely document account activity.

• Proficient with computers and technology, with an aptitude for quickly learning and mastering new software platforms.

• Prior experience specifically in denial analysis or underpayment identification.

• Familiarity with reading and interpreting payer contracts and fee schedules.

• Experience working within various payer portals and systems.

WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS:

• High School Diploma or equivalent required, Associate's or Bachelor's degree in a related field preferred.

• Minimum of 2+ years of experience in healthcare accounts receivable (AR), hospital billing, or revenue cycle resolution.

• Experience working within various payer portals and systems.

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.

Originally posted on Himalayas