Kettering Health

Role Description This network-wide position, under the direction of the Pre-Access Manager, Kettering Health is responsible for facilitating the patient intake process by performing accurate data entry of patient demographic and insurance information for patients scheduled for admission, pre-admission, and outpatient services. - Reviews insurance benefits, authorizations/referral information, and upfront patient appropriate liability when required at each encounter to ensure accurate and complete billing. - Provides exceptional customer service to patients, providers, and all other departments. - Demonstrates through behavior Kettering Health’s mission, vision, and service standards as outlined in the organization’s training. - Maintains competence and uses critical thinking skills to promptly resolve consumer inquiries within assigned functional area(s). - Adheres to all established workflows, scripting, and department greetings. - Creates delightful customer experiences by setting proper expectations and consistently following through with end-users. - Documents all interactions and consistently updates consumer records in the relevant technology system(s). - Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, and helpfulness. - Achieves individual key department performance objectives such as quality assurance and productivity. - Maintains knowledge of Pre-Access and Kettering Health offerings to provide exceptional services. - Handles sensitive matters courteously and with professionalism, escalating with leadership when appropriate. - Adheres to department policies and procedures and HIPAA regulations. - Performs other duties as assigned by department leaders. Qualifications - High school diploma required. - One-year customer service experience required. - Previous registration/medical office experience preferred. - Demonstrated competency in working in teams and ability to effectively communicate with all levels. - Proficient in computer skills and phone skills. - Ability to function in a high-paced, often stressful environment while maintaining a respectful, caring, and professional manner. - Must have the ability to perform as a collaborative team member. Requirements - Ability to articulate the mission of Kettering Health and Pre-Access. - Strong attention to detail and ability to take initiative to resolve inquiries and issues. - Demonstrated personal commitment to promoting and providing excellent customer service. - Demonstrated interpersonal, customer relations, and communication skills; remains patient while interacting with consumers and colleagues. - Exhibits desire to continuously learn, improve service delivery, and work in a team environment. - Ability to listen and document notes simultaneously. - Ability to read, analyze, and interpret verbal and written instruction. - Maintains high energy and positive attitude. - Ability to remain calm under pressure. - Adapts to change and balances multiple priorities in a fast-paced environment. - Demonstrates regular, consistent, and punctual attendance. - Effective communicator in English, both orally and in writing. - Computer Proficiency: Microsoft Office Suite programs and basic keyboard typing skills. - Technological aptitude to accomplish additional programs and technologies, including CRM, telephony, electronic health records, and other potential systems. Company Description Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God’s love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.

Job Details PFS Physician | Remote | Full-Time | First Shift Responsibilities & Requirements Responsibilities: - Under the direction of the Patient Accounts Manager or Supervisor the Patient Accounts Representative is responsible for daily billing functions including but not limited to working claim edits, review of insurance claims for accuracy, contacting various parties for further information on unpaid claims, identifying issues resulting in non-payment, and working first level appeals…all incompliance with departmental policies and procedures. - Must display knowledge retention through scheduled competency assessments. - Other duties as assigned. - Essential Skills: - Timely resolution of claim edits allowing timely claim submission - Timely follow-up of unpaid claims, worked to ensure maximum reimbursement following compliant standards - Ability to work independently as well as collaboratively within a team environment - Excellent problem-solving skills Requirements: - High School diploma or equivalent - Experience in Microsoft office tool Preferred Qualifications - Previous experience in patient billing preferred - Epic experience a plus Overview Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God’s love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.

Job Details PFS Physician | Remote | Full-Time | First Shift Responsibilities & Requirements Responsibilities: - Under the direction of the Patient Accounts Manager or Supervisor the Patient Accounts Representative is responsible for daily billing functions including but not limited to working claim edits, review of insurance claims for accuracy, contacting various parties for further information on unpaid claims, identifying issues resulting in non-payment, and working first level appeals…all incompliance with departmental policies and procedures. - Must display knowledge retention through scheduled competency assessments. - Other duties as assigned. - Essential Skills: - Timely resolution of claim edits allowing timely claim submission - Timely follow-up of unpaid claims, worked to ensure maximum reimbursement following compliant standards - Ability to work independently as well as collaboratively within a team environment - Excellent problem-solving skills Requirements: - High School diploma or equivalent - Experience in Microsoft office tool Preferred Qualifications - Previous experience in patient billing preferred - Epic experience a plus Overview Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God’s love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.

Job Details PFS Physician | Remote | Full-Time | First Shift Responsibilities & Requirements This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance and EPIC WQ Reconciliation. KPN Pro Fee Coding Specialist Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. - Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits - Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10 - Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy] - Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI edits - Corresponds with providers on pending claims to facilitate resolution - Responsible for participating in departmental goals, KHN mission and implemented KHN/KPN policies - Communicate appropriately with providers, leaders, and staff - Researches and resolves concerns timely Educational Requirements: High School Diploma or equivalent RHIT, RHIA, CCS, CCS-P, CPC or eligible specialty certification Prior experience in professional fee coding/billing Knowledge and Skill: CPT, HCPCS, Modifiers, ICD-10, and CMS NCCI Edits Medical Terminology and Anatomy & Physiology Computer and EPIC Applications Excellent verbal and written communication skills Abilities: - Charge Review WQ [Edits] - Reviews, researches and responds to Charge Review WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. - Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. - Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits - Claim Edit WQ [Edits] - Reviews, researches and responds to Claim Edit WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. - Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. - Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits - Follow Up WQ [Denials] - Reviews, researches and responds to Follow Up WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. - Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution. - Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits - Departmental Responsibilities - Responsible for participating in departmental goals, KHN mission and implemented KHN/KPN policies - Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI edits - Follow procedures pertaining to position - Researches and resolves concerns timely Overview Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.

Job Details PFS Hospital | Remote | Full-time | First Shift Responsibilities & Requirements Responsibilities: - Under the direction of the Patient Accounts Manager or Supervisor the Patient Accounts Representative is responsible for daily billing functions including but not limited to working claim edits, review of insurance claims for accuracy, contacting various parties for further information on unpaid claims, identifying issues resulting in non-payment, and working first level appeals…all incompliance with departmental policies and procedures. - Must display knowledge retention through scheduled competency assessments. - Other duties as assigned. - Essential Skills: - Timely resolution of claim edits allowing timely claim submission - Timely follow-up of unpaid claims, worked to ensure maximum reimbursement following compliant standards - Ability to work independently as well as collaboratively within a team environment - Excellent problem-solving skills Requirements: - High School diploma or equivalent - Experience in Microsoft office tool Preferred Qualifications - Previous experience in patient billing preferred - Epic experience a plus Overview Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.

Job Details PFS Hospital | Remote | Full-time | First shift Responsibilities & Requirements Responsibilities: - Under the direction of the Patient Accounts Manager or Patient Accounts Supervisor and guidance of the Team Lead the Patient Accounts Specialist is highly involved in all aspects of medical billing, and is responsible for escalated follow-up and denial work. Participates in training and auditing of Patient Account Representatives. - Works special projects as assigned. - First level of contact for Patient Account Representatives. - Must display knowledge retention through scheduled assessments. - Must role model KHN Standards of Behavior. - Other duties as assigned. - This is not considered a leadership role in regard to authority over team members. Requirements: - Strong knowledge of payer guidelines including government payers - Competent in preparing and submitting appeals for denied or delayed claims according to established protocols - Competent in identifying and communicating recurrent insurance carrier denials to Team Lead - Exceptionally well-versed in resolving errors to ensure prompt claim resolution - Timely identification of delinquent accounts and following up to expedite resolution - Expert in system (Epic) navigation - High School diploma or equivalent required - Minimum of one years’ experience in patient billing required Overview Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.

Role Description - Facilitate a collaborative process of assessment, planning, care coordination, and evaluation to meet the comprehensive health needs of identified individuals or families within the designated population. - Serve as a liaison between physicians, hospitals, emergency departments, nursing homes, and other healthcare providers and resources. - Support a multidisciplinary team approach directed toward prevention, education, and health promotion in panel of patients. - Ability to establish supportive relationships with patients, caregivers, and families. - Assist in the development of network protocols and processes for care management of high-risk and rising-risk patient populations. - Maintain focus on patient needs as well as network needs for population management. - Act as patient advocate and educator to empower patients to participate in the plan of care. Qualifications - BSN required - MSN preferred. - Minimum two (2) years clinical experience as an RN in an acute care or ambulatory/practice care setting required. - Current Ohio RN license required. - Experience with population management. - Computer literate - Excel, Access. - Excellent written and verbal communication skills. - Behavioral Health Experience Preferred. Company Description Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God’s love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.