RN Revenue Integrity

3 weeks ago

Miamisburg OH United States Kettering Medical Center Network Full time

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)



Responsibilities & Requirements

Responsibilities

* Work under the direction/supervision of the Manager
* Be responsible for analyzing revenue cycle deficiencies in order to prevent billing and regulatory claim edits, claim denials and other related charge capture obstacles by working collaboratively with Patient Access, Case Management, Contract Management, Medical Records and other Kettering Health Network departments
* Work closely and collaboratively with Patient Financial Services Commercial and Medicare/Medicaid billing teams for prompt resolution of claim delay issues in compliance with Federal guidelines
* Work to maximize revenue potential through the auditing of ALL Observation status accounts (including Observation-to-Inpatient status)
* Preparation of and participation in Defensive Audits with outside auditing agencies
* auditing of ALL Trauma admissions accounts, the auditing of specialized accounts, such as Blood Transfusion edits and the investigation and resolution of individual account audit requests, including ADR (Additional Development Request) audit requests from CMS and Hydration services denials from all payers
* The RN Revenue Cycle Coordinator acts as Patient Financial Services liaison to share audit findings and identify ways to reduce/eliminate revenue cycle barriers through process improvements and to educate ancillary departments on recommended changes and processes

Requirements

* RN degree from an accredited school of professional nursing and licensed to practice in the State of Ohio.
* RN with minimum of 5 years clinical nursing experience
* Strong understanding of the Revenue Cycle - Registration, Medical Records, Billing practices and Compliance issues
* Strong understanding of medical necessity guidelines
* Experience with computers required. Must be able to utilize and navigate the electronic medical record with accuracy and independence
* Ability to demonstrate initiative and good judgment in a self-directed role
* Ability to clearly communicate with and establish and maintain good rapport with physicians, hospital administration, nurses and other healthcare team members

Preferred Qualifications

* BS/BSN from an accredited school preferred.
* Experience with and/or knowledge of managed care contract terms and federal payer guidelines preferred.
* Experience with hospital billing (UB92 form) and coding requirements/guidelines preferred.
* Knowledge of federal, state, industry-wide utilization and billing regulations preferred.

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