Ovation Healthcare

Medical Billing and Coding

• Responsible for critical access hospital coding including emergency department and infusions
• Ensure timely and accurate coding of medical claims while maximizing reimbursement for services
• Abstract clinical information and translate medical documentation into codes
• Maintain current knowledge of coding rules and regulations
• Communicate issues to management regarding coding and billing
• Participate in department meetings and continuing education programs
• Ensure confidentiality of patient information and compliance with policies

Hospital Outpatient Coder

Program Manager

• Lead enterprise-level projects and programs internally and externally, from initiation through closing
• Manage complex, multi-workstream efforts involving cross-functional teams, including service line expansion, technology implementation, financial optimization, or M&A integration
• Own project and program timelines, milestones, project grids, logs and success metrics
• Ensure proper sequencing of efforts, workstream alignment, and visibility of risks and issues
• Serve as the primary project execution lead for client engagements
• Facilitate external meetings and working sessions with client stakeholders
• Ensure internal teams are aligned, prepared, and equipped to deliver with excellence
• Partner closely with the Group Vice President (account owner) to deliver insights, summaries, and updates to the client
• Own the development and management of client-facing materials (status reports, dashboards, deliverables)
• Lead internal execution calls across multiple functional areas
• Ensure project owners are on track, supported, and held accountable
• Capture action items, decisions, and project risks while facilitating productive execution-focused meetings
• Coordinate data collection and resource alignment across teams
• Support the identification, prioritization, and activation of strategic initiatives during the strategic planning process
• Create project charters, execution roadmaps, and kickoff materials
• Implement standardized project management tools, templates, and routines across engagements
• Drive consistency in delivery and performance tracking
• Serve as a senior execution lead and mentor to junior project professionals
• Help maintain and refine the organization’s execution framework and best practices
• Participate in governance structures and provide recommendations to senior leadership

Program Manager, Performance Optimization

Manager

• Develop, implement, and maintain revenue integrity programs to ensure accurate charge capture, coding, billing, and reimbursement.
• Identify, analyze, and mitigate revenue leakage across inpatient, outpatient, and ancillary services.
• Conduct regular audits of charges, coding, billing edits, and reimbursement patterns.
• Collaborate with facility HIM & Compliance teams to ensure completeness and accuracy of medical records.
• Support accurate DRG/APC/ProFee assignment and appropriate reimbursement.
• Evaluate coding trends and provide education to coding staff, clinicians and other contacts.
• Ensure compliance with federal, state, and payer regulations (CMS, HIPAA, OIG, etc.).
• Establish and maintain internal audit programs for clinical documentation, coding accuracy, and billing compliance.
• Prepare documentation and support external audits and regulatory reviews.

Manager, Quality – Revenue Integrity

QA Engineer

• Generate, update, and distribute reports as required, ensuring accuracy, timeliness, and relevance for team and management review.
• Conduct call monitoring to assess agent performance, identify key trends, and provide actionable insights to the management team to drive performance improvements.
• Analyze data from the quality management system to evaluate both team and individual performance, delivering constructive feedback to support continuous improvement.
• Leverage customer service expertise to assess current practices, proactively identifying areas for improvement and recommending process enhancements.
• Facilitate weekly QA training sessions for agents, focusing on enhancing call quality and aligning with performance standards.
• Collaborate with leadership to mentor agents and guide them in improving call quality scores, providing support and development opportunities.
• Coordinate and lead call calibration sessions with management, selecting calls for review, documenting key takeaways, and driving collaborative discussions to ensure alignment on quality expectations.
• Assist other departments in locating missing calls from Five9, ensuring smooth issue resolution and continuous workflow.
• Perform other related tasks as assigned, contributing to the success and effectiveness of the team and department.

Quality Assurance Specialist

• Review medical records for outpatient or same day surgical procedures
• Assign appropriate diagnostic and procedural codes (CPT and ICD-10)
• Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding
• Submit necessary provider queries to resolve documentation discrepancies
• Perform quality assessment of records, including verification of medical record documentation
• Review appropriate charges and make changes or recommendations based on the documentation
• Research errors or missing documentation from medical records to provide accurate coding processes
• Abstracts and assigns the appropriate ICD-10-CM and CPT codes for all diagnoses and procedures

Coder, SDS

Accounts Receivable

• Follow-up with insurance payers on outstanding claims
• Break down obstacles to payment and accelerate cash collections
• Utilize experience and follow-up strategies and tools to resolve claims
• Document client’s host system using the 5 W’s framework
• Write first and second level appeals of all denials
• Escalate unpaid claims to payer claims supervisor as appropriate
• Research and analyze any correspondence related to assigned accounts

Accounts Receivable Specialist

Engineer

• Support setup, diagnosis, repair, maintenance and upgrades of desktop hardware and computer equipment
• Provide hands-on or remote technical support for computer setups, software installations, upgrades, and maintenance tasks
• Troubleshoot and resolve desktop-related issues to ensure timely and efficient service delivery
• Install, configure, and maintain desktop hardware, software, and peripherals
• Perform routine maintenance tasks including updates and patch management
• Set up and manage user accounts, profiles, and permissions
• Assist with user onboarding and offboarding processes
• Maintain security measures such as antivirus software and encryption protocols
• Collaborate with IT team to safeguard sensitive data and prevent security breaches

Desktop Engineer

• Support with strategic oversight to direct, manage, and improve the revenue cycle operations
• Conduct daily, weekly, monthly, quarterly, and annual analysis of Key Performance Indicators (KPIs)
• Serve as the internal revenue cycle liaison for hospital leadership
• Work with hospital leadership to ensure understanding of revenue cycle processes and metrics
• Supervise multiple Managers and provide guidance and mentoring
• Recommend and establish changes to policies or processes to improve the revenue cycle
• Develop actions plans for metrics not meeting established goals
• Facilitate meetings with regional leaders to report financial performance and improvement plans

Director, Accounts Receivable

Consultant

• Proficient use of healthcare data and analytical tools
• Prepares deliverables aligned to project goals and objectives
• Applies specialized knowledge and skills to address client issues
• Participates in key strategic interviews with clients
• Drafts sound and well-structured recommendations

Associate Consultant, Strategy

• Oversee the operations of the Follow Up team.
• Identify opportunities to improve efficiency and overall process improvement.
• Manage Multiple Specialties.
• Implement process changes within the unit.
• Coordinate training needs.
• Guide Team Leads to the correct resolutions.
• Monitor PTO and flex time requests.
• Review Daily Workflows.
• Complete performance reviews.
• Closely monitor all claims over 60 days old.
• Identify/Resolve trending AR issues.
• Report directly to VP of Revenue Cycle.

Manager, Follow Up

Customer Success Manager

• Lead end-to-end implementation of GPO services for new and transitioning healthcare clients.
• Develop and manage detailed project plans, timelines, and deliverables.
• Coordinate cross-functional teams (Supply Chain, Pharmacy, Finance, IT, Vendors).
• Oversee item master and formulary conversion to align with GPO contracts.
• Ensure accurate and timely setup of contract pricing, tiers, and distribution agreements.
• Validate savings opportunities through benchmarking and cost analysis.
• Conduct financial analysis as necessary for contract tier optimization.
• Act as the primary point of contact for clients during implementation.
• Conduct regular status meetings, provide progress reports, and manage issue resolution.
• Support client education on GPO model, compliance, and reporting tools.
• Guide hospital leadership and supply chain teams through transition from prior GPO.
• Facilitate adoption of new processes, policies, and compliance requirements.
• Address barriers to implementation and escalate risks as needed.
• Track realized savings against pro forma projections.
• Provide reporting on compliance, contract utilization, and cost reduction.
• Transition client to ongoing account management team post-implementation.

Client Success Manager

• Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding
• Resolve medical record documentation deficiencies through healthcare provider query, and provide routine feedback to healthcare providers to correct deficiencies
• Perform quality assessment of records, including verification of medical record documentation (both electronic and handwritten)
• Responsible for researching errors or missing documentation from medical record, in order to provide accurate coding processes
• Abstract and assign the appropriate ICD-10, HCPCS/CPT codes; including Level I & Level II modifiers as appropriate for all diagnosis and procedures performed in an outpatient and inpatient setting.