Kettering Medical Center CONTRACT MGMT COMPLIANCE COORDINATOR in Miamisburg, Ohio

Description The Compliance Coordinator shall be responsible for monitoring post service administrative and clinical denials/appeals from managed care, government and third party payers. Will work with payers to ensure inappropiate denials/appeals are not received. The Complaince Coordinator shall assist the Manager of Denials Management in tracking denials utilizing denial management software. This involves identifying issues, reviewing hospital processes resulting in denials, providing supplemental information for pre-cert/pre-authorization and overturning denials. Activities include the analyzing, tracking and monitoring of denial statistics and trends. Acts as a consultant for Case Management staff in the area of concurrent denial prevention and management. Works closely with PFS commercial and Medicare/Medicaid billing teams for prompt resolution of denials, accurate reimbursement and the billing of claims in compliance with Federal guidelines.

Requirements RN degree from an accredited school of professional nursing and licensed to practice in the State of Ohio. BS/BSN from an accredited school preferred. Minimum of 5 years clinical experience required. Appeal/Denials Management and Case Management/Utilization Management experience required. Experience with managed care contract requirements and federal payer guidelines preferred. Strong understanding of medical necessity guidelines. Experience with computers required. Must be able to use word processing and graphics programs. Additional experience with statistics or database programs helpful. Knowledge of billing practices and compliance issues required. Knowledge of federal, state, industry utilization and quality improvement and billing regulations and their application required.

Requisition Number: 16-6040


Department: REVENUE MANAGEMENT - 930093

Location: Admin Support Building

City: Miamisburg

State: Oh

Shift: First

Job Status: Full-Time

Temporary: No

Hours per Bi-Weekly Pay Period: 80