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.
Identify and assess billing compliance, operational and financial risks within the employed physician network, Kettering Physician Network (KPN). Audit and monitor physician practices for compliance with existing policies and government regulations. Develop compliance and education plans, policies and procedures that affect operations and assure recommendations to minimize risk are implemented timely and effectively.
1. Conduct internal audits to review coded and abstracted data for accuracy and quality in order to ensure coding compliance for the KPN.
a. Prepare written reports of audit findings and recommendations to minimize risk
2. Performs general and targeted audits.
3. Identifies rejected claims due to coding and billing errors.
4. Assists in the development of Coding Compliance Action Plans in response to audit findings and makes recommendations as necessary.
5. Provides compliance education and training as necessary.
6. Assists in the development of the Corporate Integrity Annual Work Plan.
7. Collaborates with appropriate colleagues and KPN leaders in the development of improved capabilities in the areas of documentation, coding, and compliance.
8. Responds to questions regarding documentation, and coding issues.
9. Participates in the claims review processes.
10. Assists in the review of contracts for compliance issues.
11. Maintain in depth understanding of federal and state laws and regulations pertaining to billing and coding compliance within KPN