Kettering Health Network

Manager Revenue Integrity - Miamisburg - Rev Intergrity - Full Time - Days

Posted Date 2 months ago(8/30/2021 10:10 PM)
Job ID
2021-31084
Job Category
Management
Job Type
Full-Time
Shift
First Shift
# of Openings
1
Shift Time
days
FTE
80 Hours Per Pay Period/FTE 1.0

Overview

KH Logo Horizontal

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.

 

Our MissionOur VisionOur Values

Responsibilities & Requirements

Responsibilities:

 

  • Strong understanding of the auditing process related to Compliance guidelines and regulations.  
  • Ability to manage auditing staff, Nurse Auditors and Patient Account Specialists, both in office and remote (work from home) locations 
  • Provide education to, and work collaboratively with, interdepartmental leadership, such as Billing, Case Management, Quality, HIMs, and Compliance.  
  • Provide leadership and guidance for team members in resolution of auditing challenges.   
  • Provide support and education to peers and other PFS staff, when requested.   

 

Requirements:

 

  • RN degree from an accredited school of professional nursing and licensed to practice in the State of Ohio.   
  • BSN required/MSN preferred 
  • RN with minimum of 5 years clinical nursing experience required. 
  • Strong and effective leadership skills required.  
  • Strong understanding of medical necessity guidelines required.  
  • Appeal/Denials Management and/or Case Management/Utilization Management experience required.  
  • Understanding of the Revenue Cycle process required.  
  • Knowledge of managed care contract requirements and federal payer guidelines required.   
  • Experience with computers required. 
  • Must be able to utilize and navigate the electronic medical record with accuracy and independence. 
  • Knowledge of other databases and software helpful.  
  • Knowledge of federal, state and industry utilization and quality improvement regulations and their application required. 
  • Knowledge of billing practices/regulations and compliance issues required. 
  • Strong professional verbal and written communication skills required. 
  • Strong analytical ability and critical thinking skills required.  
  • Ability to accept responsibility, make decisions and recommendations required. 
  • Ability to demonstrate initiative and good judgment in a self-directed role required. 
  • Ability to manage job functions and demonstrate flexibility, despite shifting priorities, required.   
  • Demonstrate integrity, objectivity and self-confidence. 
  • Ability to clearly communicate with and establish and maintain good rapport with physicians, hospital administration, nurses and other healthcare team members required. 
  • Knowledge and understanding of KHN’s quality improvement and utilization management criteria preferred.    
  • Experience with hospital billing (UB92 form) and coding requirements/guidelines preferred. 
  • Registered Nursing degree, licensed to practice in the State if Ohio   
  • BS/BSN required 
  • MSN preferred 

 

 

 

Preferred Qualifications

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