PFS Specialty Team Lead - PFS Call Center - Miamisburg -FT/Days Job Listing at Kettering Health in United States of America (Job ID 2025-53847)

Description

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.

Responsibilities:

• Under the direction of the Patient Accounts Manager or Patient Accounts Supervisor the Patient Accounts Team Lead/Educator 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 Specialists & Representatives.  
• Works special projects as assigned. 
• Effective in identifying and analyzing problems.
• Generates alternatives and identifies possible solutions.
•  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
•  Creative ability to escalation of appeals
•  Excellent verbal, written and customer service communication skills.

Requirements:  

• Experience in Microsoft tools Epic EMR Experience (Preferred) Relay Health/ePremis Experience (Preferred)      
• High School diploma or equivalent required
• Minimum of one years' experience in health care denials
•  Experience with the Revenue Cycle – registration, medical records, billing, coding, etc.
•  Experience with managed care contract terms and federal payer guidelines
•  Experience with medical necessity guidelines and care coordination/case management functions
•  Experience with hospital billing (UB92 form) and coding requirements · Understanding of Revenue Cycle Processes
•  In depth understanding of explanation of benefits (EOB's)