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: Ovation Healthcare is seeking a billing specialist. The Billing Specialist is responsible for managing the daily billing and ensuring timely accurate clean claims, claim reviews and resolves billing daily claim edits and ensuring compliance with Insurance billing policies and regulations. Duties and Responsibilities: - Extensive understanding of billing guidelines for UB/1500 claims and a deep understanding of each claim field requirement. - Maintain a list of split billing requirements by payer and add to the team crosswalk and keep abreast of any payer changes. The billing specialist should be well versed in Payer portal appeal uploads and assist with providing the internal team feedback when necessary. - Import claims from host system into claims processing system when required. Review claims that are pended for edits and resolve. - Prepare and submit accurate claims for patient services, ensuring compliance with third party payer guidelines and regulations. - Review patient accounts and reconcile payments with secondary payers and review remittance advice, ensuring all payments are posted correctly and outstanding balances are addressed before filing the secondary payer. - Ensure all billing and collection practices are compliant with CMS regulations, HIPAA, and company policies. Maintain accurate records of all claims and ensure proper documentation in the patient account system. - Meet daily productivity and quality standards as assigned. - Work with internal departments, such as patient financial services, finance, and billing, to address any issues or disputes affecting patient accounts. - Assist management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows. Knowledge, Skills, and Abilities: - Proven experience in third party insurance billing, collections, or patient accounts, preferably in a healthcare setting. - In-depth knowledge of billing codes, guidelines, and regulations. Familiarity with electronic health record (EHR) systems, billing software, and remittance advice processing. Strong communication skills, with the ability to explain Medicare billing details and resolve patient concerns effectively. - Ability to handle sensitive information and maintain confidentiality in accordance with HIPAA regulations. - Detail-oriented with strong organizational skills and the ability to manage multiple accounts simultaneously. - Problem-solving abilities, particularly regarding billing discrepancies and denied claims.

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Overview The Physician Coding Denials Specialist is responsible for reviewing and appealing coding denials for all assigned professional service claims related to Evaluation and Management coding. Closely works with Charge Coding & Revenue Management leaders and Account Resolution teams to provide feedback to providers/practices to improve clinical documentation and facilitate ongoing documentation improvement. Responsible for performing appeals for the Wellstar MGBO for professional services as deemed necessary. Monitor's denial work queues within Epic (Electronic Health Record) to ensure timely appeal deadlines are met. Must ensure timely, accurate and thorough appeals for all accounts assigned and apply critical thinking skills to ascertain root cause of denials. Uses analytical skills to identify trends in payer denials and translates this information into Charge Review edits that will be used to prevent future denials. Assists in development and implementation of training for charge capture specialists. Responsibilities Core Responsibilites and Essential Functions - Coding Denials Management * Identify major reasons for denials root causes (Diagnosis, procedure codes, etc.) * Work collaboratively with charge coding and revenue management to provide coding and documentation feedback to practices/providers. * Utilize Epic to review account denial audits and perform trend analyses to identify patterns and variations in coding denials and practices. * Maintain open communication with Wellstar Medical Group providers and practices to facilitate denial/appeals process. * Review clinical records to identify overcharges, undercharges or charges that necessitate additional documentation. * Research and analyze charge and coding requirements for new services and technology. * Consistently meet current productivity and quality standards as assigned by department manager in ensuring accurate account follow-up. - Analysis and Interpretation of Trends * Identify opportunities for system and process improvement and submit to management. * Working with MGBO Edit Committee, physician coding compliance and Epic Connect, translate identified trends into Epic charge review rules. * Evaluates and adheres to clinical and billing policies, guidelines, and regulations of both commercial and governmental payors. * Appeals denials or instructs the resubmission of claims based on compliant medical record documentation and Wellstar Medical Group/MGBO policies and procedures. * Asses need for formal appeals of all clinical denials including but not limited to preauthorization of practice encounters and procedures, and for retroactive recovery reviews regarding medical necessity and limited billing compliance. - Professional Communication * Communicate with all internal contacts in a professional manner including providers, practice staff, co-workers, management, and clinical staff. * Communicate with all external contacts in a professional manner including representatives from third party payor organizations. * Interact with internal customers/departments including HIM, Charge Coding and Revenue Management, Patient Access and the Single Business Office in a professional manner to achieve revenue cycle department accounts receivable goals and objectives. * Assure patient privacy and confidentiality as appropriate or required. * Initiate communication with peers about changes in payor policies and internal policies and procedures. * Prepare appeal letters that are specific, concise, and conclusive; providing payors with appropriate clinical documentation as needed. * Provide feedback to physicians, providers and management in a timely and professional manner. - Department Methods, Procedures and Operations * Follow department guidelines for lunch, breaks, requesting time off, and shift assignments. * Demonstrate knowledge of the health system HIPAA privacy standards and ensure compliance with system PHI privacy practices. * Follow the health system’s general Policy and Procedures, the Department’s Policy and Procedures, and the Emergency Preparedness Procedures. * Follow JCAHO and outside regulatory agencies’ mandated rules and procedures. * Participate in the testing for assigned software applications, including verification of field integrity. * Perform other duties and responsibilities as assigned. Required for All Jobs - Performs other duties as assigned - Complies with all Wellstar Health System policies, standards of work, and code of conduct. Qualifications Required Minimum Education - High school diploma or equivalent Required - AAPC or AHIMA professional coding certification required Required or - >5 years of experience is acceptable with a professional certification within 90 days of employment Required or - If enrolled in a coding program within 90 days of graduation. Proof of enrollment required. Required Minimum Experience - Minimum 2 years of Healthcare Account Resolution experience or Physician billing experience, including professional coding experience. Required Required Minimum Skills - High level problem solving, analytical and investigational skills to research and resolve denied accounts. - Technical skills to include Microsoft Office (Word, Excel, PowerPoint, Teams), EMR systems (Epic), graphs and tables experience and personal computers. Strong time management skills to independently manage multiple priorities and a heavy workload. - Demonstrated flexibility to perform other tasks as needed in an active work environment with changing work needs. - Ability to prioritize assignments to meet deadlines. - Proven communication skills and positive motivational skills. - Medical terminology and or anatomy/physiology, ICD-10, and E/M coding. Understand governmental and commercial payor compliance regulations. Required Minimum License(s) and Certification(s) - Cert Prof Coder Preferred Additional Licenses and Certifications - AAPC or AHIMA professional coding certification Required - CPB Preferred Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.

*Candidate must have direct experience working on the Centers for Medicare & Medicaid Services Risk Adjustment Data Validation (CMS RADV) contract. *Day time availability is required due to meetings Position Summary The Coding Compliance Specialist is responsible for overseeing and evaluating assigned Risk Adjustment Data Validation (RADV) medical record review (MRR) work performed under the contract. This role ensures compliance with CMS RADV guidelines, coding standards, and risk adjustment policies while maintaining the highest quality and accuracy in medical record documentation. This is a part-time, remote position with flexible scheduling, ideal for experienced professionals seeking autonomy and work-life balance. Key Responsibilities - Ensure adherence to CMS RADV payment and risk adjustment policies. - Provide expert guidance on coding and documentation standards, including ICD-CM, HCC, and Risk Adjustment. - Review escalated Medicare RADV medical record cases and resolve complex issues. - Maintain quality assurance and compliance across all RADV review activities. - Collaborate with stakeholders to improve processes and ensure contractual obligations are met. - Conduct medical record, coding, and policy research. - Develop and deliver training programs related to RADV and coding compliance. - Perform medical record reviews involving PHI/PII, identify conflicting documentation, and provide coding clarifications. Experience Requirements - Prior experience working directly on the CMS RADV contract is required - Minimum 5 years of supervisory experience in medical record review, preferably RADV. - Proven expertise in reviewing escalated Medicare RADV medical record cases. - In-depth knowledge of RADV Medical Record Review (MRR) processes, ICD-CM coding standards, CMS RADV payment and risk adjustment policies, and documentation guidelines. Education & Certification - Medical Coding Certification from an accredited entity (e.g., AAPC, AHIMA). - RHIT, RHIA, CCS, CPC, CRC - Advanced knowledge of coding systems and compliance regulations. Skills & Competencies - Strong analytical and problem-solving skills. - Excellent communication and leadership abilities. - Detail-oriented with a commitment to accuracy and compliance. - Ability to manage multiple priorities and meet deadlines.

Company Description Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers Job Description The RCM Training and Workflow Associate delivers comprehensive virtual athenaOne Collector/Billing training to Care Centers during implementation and post live. This role involves triaging stakeholder issues and requests, and ensuring athenaOne collector training aligns with best practices. The associate maintains current knowledge of new features in athenaOne’s Collector, Clinicals, and Communicator products to optimize workflows for Privia Medical Group Care Centers. The RCM Training and Workflow Associate actively seeks feedback to continually elevate Privia’s RCM and training program to a best-in-class standard. Job responsibilities: - Lead pre-live and post-live athenaOne Collector/billing training to providers, administrative and billing staff in all markets - Ensures that training is scheduled and delivered on-time - Innovate and create new learning experiences for Care Centers for Privia University (LMS). - Provide onsite Go-Live support for New Market and/or high-profile Care Centers - Offer supplemental training opportunities applicable to all markets. - Works collaboratively with cross functional teams to accomplish goals - Share and effectively communicate new athenaOne features regularly - Provides excellent customer service through creative problem solving and follow through - Other duties as assigned Qualifications - Experience with Revenue Cycle Management and Physician office billing required - 2+ years experience with client facing training preferred - 2+ years experience with practice management systems, one or multiple areas of expertise preferred - Experience with athenaOne’s Clinicals and Collector software preferred - Bachelor’s degree preferred - Demonstrated experience in development and editing instructional material - Knowledgeable about extended medical terminology - Must demonstrate excellent communication, organizational, and time management skills - Must demonstrate strong interpersonal skills to interact positively and productively with a variety of personnel within teams and across organizational lines - Ability to work in a very fast-paced and changing work environment - Must comply with HIPAA rules and regulations - Collaborative, customer-focused and able to create visible value. - Team approach to working with others, ability to perform a variety of duties within any work-day and organizational skills from planning to execution of tasks and projects. - Attention to detail. - Excellent communication and client facing skills. - Excellent organizational skills. The salary range for this role is $60,000,00 to $65,000,00 in base pay and exclusive of any bonus or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location. Additional Information All your information will be kept confidential according to EEO guidelines. Technical Requirements (for remote workers only, not applicable for onsite/in office work): In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost. Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law. - Department: Revenue Cycle