PFS Specialty Team Lead - PFS Call Center - Miamisburg -FT/Days

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.

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 facility
• Awarded 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)

Department Overview

The  PFS Specialty Team Lead  is responsible for monitoring denials, appeals, takebacks, and resolutions from insurance carriers and working proactively to collect outstanding denied accounts. The job responsibilities and duties include: Identifying, analyzing, and researching frequent root causes of denials and develop corrective action plans for resolution of denials. Position will be required to be detailed oriented and formulated appeals researching and analyzing denial data and coordinating denial recovery responsibilities. Candidate will be required to be knowledgeable, understand, and apply critical thinking skills to the correct appeal methodology to help address various denials such as proving medical necessity and retro authorizations appeals. Team Lead/Educators are required to apply the proper escalation of outstanding denials including submitting complaints to various agencies such as the Ohio Department of Medicaid and the Department of Insurance. In additional to denials, employee will address pre and post takebacks by health plans that are required to be investigated and appropriate action taken. Team Lead/Educators must prioritize activities to work overturns in a timely manner to alleviate untimely filings is a must. Working with Insurance payers to ensure proper billing takes place on all assigned patient accounts. Depending on payer contract may be required to participate in conference calls, accounts receivable reports, compiles the issue report to expedite resolution of accounts. Works follow up report daily, maintaining established goal(s), and notifies Manager and/or Supervisor, of issues preventing achievement of such goal(s). Follows up on daily correspondence to appropriately work patient accounts. Assists customer service with patient concerns/questions to ensure prompt and accurate resolution is achieved. Produces written correspondence to payers and patients regarding status of claim, requesting additional information, etc. Initiates next billing, assign appropriate follow-up and/or collection step(s), this is not limited to calling patients, insurers, or employers, as appropriate. Sends initial or secondary bills to Insurance payers. Documents billing, follow-up and/or assign collection step(s) that are taken and all measures to resolve assigned accounts. escalation to Supervisor/Manager of any issues or changes in billing system, insurance carrier, and/or networks. Works other duties as assigned.

Responsibilities & Requirements

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.

Preferred Qualifications

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)