Kettering Health

Kettering Health.

  • Miamisburg, OH


  • Irreversible.

  • Full-time.

Overview

Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient centers serving southwest Ohio. We are devoted to changing the healthcare experience with premium look after every phase of life. Our service-oriented objective is in action every day, whether it’s by offering care in our centers, training the next generation of healthcare specialists, or serving others through global outreach.

Responsibilities & Requirements

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

Responsibilities:

  • Serves as the subject professional making sure coding compliance, understanding of CMS billing guidelines and policies and functions as an expert cost coding resource to network service lines.
  • Demonstrates understanding of CPT, HCPCS, ICD-10 and CMS NCCI modifies
  • Accurately examine documents in EPIC EMR to designate suitable CPT, HCPCS and ICD-10
  • Reviews and investigates pending and rejected claims relating to expert cost coding, CMS NCCI modifies, and/or medical need requirements [CMS LDC/NCD and/or payer policy]
  • Demonstrate effort for keeping present understanding of CPT, ICD-10 and CMS NCCI modifies
  • Corresponds with service providers on pending claims to assist in resolution
  • Responsible for taking part in department objectives, KHN objective and executed KHN/KPN policies
  • Communicate properly with service providers, leaders, and personnel
  • Researches and solves issues prompt

Requirements:

  • High School Diploma or comparable
  • RHIT, RHIA, CCS, CCS-P, CPC or qualified specialized accreditation
  • Prior experience in expert charge coding/billing
  • CPT, HCPCS, Modifiers, ICD-10, and CMS NCCI Edits
  • Medical Terminology and Anatomy & Physiology
  • Computer and EPIC Applications
  • Excellent spoken and written interaction abilities

Abilities:

  • Charge Review WQ [Edits]
  • Reviews, looks into and reacts to Charge Review WQ modifies relating to coding, CMS NCCI modifies, and/or medical need requirements to assist in resolution.
  • Corresponds and interacts properly with companies on coding, CMS NCCI modifies, and/or medical requirement requirements to assist in resolution.
  • Demonstrates understanding of CPT, HCPCS, ICD-10 and CMS NCCI modifies
  • Claim Edit WQ [Edits]
  • Reviews, looks into and reacts to Claim Edit WQ modifies referring to coding, CMS NCCI modifies, and/or medical requirement requirements to assist in resolution.
  • Corresponds and interacts properly with suppliers on coding, CMS NCCI modifies, and/or medical need requirements to assist in resolution.
  • Demonstrates understanding of CPT, HCPCS, ICD-10 and CMS NCCI modifies
  • Follow Up WQ [Denials]
  • Reviews, looks into and reacts to Follow Up WQ edits relating to coding, CMS NCCI modifies, and/or medical requirement requirements to assist in resolution.
  • Corresponds and interacts properly with service providers on coding, CMS NCCI modifies, and/or medical requirement requirements to help with resolution.
  • Demonstrates understanding of CPT, HCPCS, ICD-10 and CMS NCCI modifies
  • Departmental Responsibilities
  • Responsible for taking part in department objectives, KHN objective and carried out KHN/KPN policies
  • Demonstrate effort for keeping existing understanding of CPT, ICD-10 and CMS NCCI modifies
  • Follow treatments referring to position
  • Researches and fixes issues prompt

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Kettering Health.

  • Apply Now.