Kettering Health Network Job - 39197150 | CareerArc
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Company: Kettering Health Network
Location: Miamisburg, OH
Career Level: Associate
Industries: Healthcare, Pharmaceutical, Biotech

Description

 

Kettering Health is a not-for-profit network of nine hospitals, Kettering College, and over 160 outpatient facilities serving southwest Ohio. Patients have access to high quality maternity care, state-of-the-art cancer fighting technology, Ohio's leading heart hospital, as well as revolutionary brain and spine surgery. With nearly 14,000 employees and 2,100 physicians, Kettering Health is committed to transforming the healthcare experience with world class health services for every stage of life. 
 
Kettering Health recently celebrated the 50th anniversary of Kettering Medical Center. 
 

As a faith-based organization we are dedicated to treating all patients with love and respect regardless of religious preference. Multi-denominational Spiritual Services are offered at the network every day. 

 



Requirements

This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance and EPIC WQ Reconciliation. 

 

Responsibilities:

 

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

 

Requirements:

 

  • High School Diploma or equivalent
  • RHIT, RHIA, CCS, CCS-P, CPC or eligible specialty certification
  • Prior experience in professional fee coding/billing
  • 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:

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

 

 


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