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.
Campus Overview
Kettering Health Miamisburg
Serving the residents of Warren, Butler, and Southern Montgomery counties for over 40 years.Kettering Health Miamisburg, formerly Sycamore Medical Center, is a full-service hospital located minutes west of the Dayton Mall on Miamisburg-Centerville Road off I-75 in Miamisburg, Ohio. The cornerstone services for KH Miamisburg have been Bariatric surgeries and Orthopedic care. Expanded services include emergency care, sleep center, mammography, breast MRI, cardiac catheterization lab, wound center and DEXA scanning. 142 bed facilityAwarded with 100 Top Hospital by IBM Watson Health for the 10th time in 2019.In 2020, KH Miamisburg received an “A” from the Leapfrog Group, a national patient safety watchdog, ranking among the safest hospitals in the United States.Accredited by the American College of Emergency Physicians as a Level 3 Geriatric Emergency Department.KH Miamisburg received several awards from Healthgrades: Outstanding Patient Experience Award (2017-2019)America’s 100 Best Hospitals for Prostate Surgery Award (2020)Joint Replacement Excellence Award (2020) Responsibilities & RequirementsThis 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 editsAccurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10Reviews 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 editsCorresponds with providers on pending claims to facilitate resolutionResponsible for participating in departmental goals, KHN mission and implemented KHN/KPN policiesCommunicate appropriately with providers, leaders, and staffResearches and resolves concerns timely
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 ResponsibilitiesResponsible for participating in departmental goals, KHN mission and implemented KHN/KPN policiesDemonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI editsFollow procedures pertaining to positionResearches and resolves concerns timely
Preferred Qualifications
Educational Requirements:
High School Diploma or equivalent
RHIT, RHIA, CCS, CCS-P, CPC or eligible specialty certification
Prior experience in professional fee coding/billing
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