Kettering Health

Expanded services include emergency care, sleep center, mammography, breast MRI, cardiac catheterization lab, wound center and DEXA scanning.. Strong knowledge of various insurance payers and their clinical guidelines for pre-certification.. Strong knowledge of insurance payer requirements for pre-authorization and pre-determination of services.. Interacts with patients, insurance companies, Case Managers, physicians’ offices, ancillary department staff, Medicaid Eligibility staff, and PAS staff in a polite, respectful, and professional manner.. Maintaining Kettering Health Network goals of registration accuracy, insurance verification, pre-registration, and other healthcare industry standards or trends in which Patient Access Services metrics of measurement are based.

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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 <ul><li> Serving the residents of Warren, Butler, and Southern Montgomery counties for over 40 years. </li><li> 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. </li><li> The cornerstone services for KH Miamisburg have been Bariatric surgeries and Orthopedic care. </li><li> Expanded services include emergency care, sleep center, mammography, breast MRI, cardiac catheterization lab, wound center and DEXA scanning. </li><li> 142 bed facility </li><li> Awarded with 100 Top Hospital by IBM Watson Health for the 10 th time in 2019. </li><li> 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. </li><li> Accredited by the American College of Emergency Physicians as a Level 3 Geriatric Emergency Department. </li><li> KH Miamisburg received several awards from Healthgrades:</li><ul><li> Outstanding Patient Experience Award (2017-2019) </li><li> America’s 100 Best Hospitals for Prostate Surgery Award (2020) </li><li> Joint Replacement Excellence Award (2020) </li></ul></ul>Responsibilities & Requirements ESSENTIAL FUNCTIONS <ul><li> Reviews all Verified Inpatient Accounts or any new Self Pay Admission within 24 hours of Admission to ensure all Self Pays, and or any insured accounts with an out-of-pocket liability have received financial dialogue regarding payment options, including Medicaid Screening and Financial Assistance (HCAP &/or EXT/Basic) if needed.</li><li> Interacts and communicates with various departments, physicians’ offices, Case Management, Central Scheduling, and front line Registration regarding insurance requirements and needed authorization for various procedures.</li><li> Strong knowledge of various insurance payers and their clinical guidelines for pre-certification.</li><li> Determines needed information is available prior to procedure processing.</li><li> Strong organization skills with ability to structure the workday to capitalize on productivity.</li><li> Ability to multi-task and focus during constant interruptions.</li><li> Enters medical information accurately and with minimal errors based on information provided.</li><li> Demonstrates excellent customer service skills.</li><li> Ensure all communication with internal and external contacts is positive, clear, and effective.</li><li> Responsive to feedback for improvement and coaching which corrects risky behaviors then applies learning to next situation.</li><li> Demonstrates continued progress by improving competencies and skill development.</li><li> Performs at a level of quality as measured by reports, manual audits and/or observation.</li><li> Provides patients and ordering physicians with information regarding needed authorization prior to patient’s arrival.</li><li> Strong knowledge of insurance payer requirements for pre-authorization and pre-determination of services.</li><li> Support Peers and others with prior authorization services.</li><li> Follows through to verify that authorization has been documented as needed.</li><li> Meets KHN as well as Industry Standards for accuracy of Pre-Registrations and Financial Clearance Standards.</li><li> Interacts with patients, insurance companies, Case Managers, physicians’ offices, ancillary department staff, Medicaid Eligibility staff, and PAS staff in a polite, respectful, and professional manner.</li><li> Demonstrates that communication on an intra and interdepartmental basis is positive.</li><li> Utilizes Passport and other Online Resource tools to verify Insurance Eligibility, Benefits and authorization requirements.</li><li> Documents all information regarding the payer requirements and any process related to authorization, benefits and case management on the patient’s account insuring any person that touches account is aware of the arrangements, insurance information plus benefits and the patient financial responsibility.</li><li> Maintaining Kettering Health Network goals of registration accuracy, insurance verification, pre-registration, and other healthcare industry standards or trends in which Patient Access Services metrics of measurement are based.</li><li> Understanding of general safety, fire safety, equipment management, hazardous materials, right-to-know, disaster plan, universal precautions and infection control.</li><li> Follows job safety requirements. Reports accidents or incidents within 24 hours of occurrence to immediate supervisor.</li><li> Keep director and supervisor informed of issues.</li><li> Travels between network facilities to support Patient Access departments.</li><li> Proficient in Outpatient Registration, Emergency Room Registration, and patient work queues.</li><li> Assist the Executive Director, Director(s) and Manager(s) in all duties assigned or directed</li><li> Assist with projects as assigned by the Network Supervisor of Patient Access</li><li> Obtaining understanding of Revenue Cycle including admission, billing, payments and denials </li></ul>Preferred Qualifications JOB REQUIREMENTS Minimum Education <ul><li> High school diploma required</li><li> College degree preferred in finance or healthcare field </li></ul>Minimum Work Experience <ul><li> One or more years of medical office or customer service experience required</li><li> Previous registration or scheduling experience strongly preferred </li></ul>Required Skills <ul><li> Demonstrated Patient Experience excellent</li><li> Excellent written and oral communication skills</li><li> Meets Pre-Screening Protocol and testing for proficiencies in computer skills, phone skills, and customer service knowledge</li><li> Knowledge of Insurance Terminology and processes</li><li> Knowledge of Insurance portals and websites</li><li> Strong third-party billing background preferred</li><li> Demonstrated competency in working in teams and ability to effectively communicate with all levels</li><li> Ability to learn site specific patient processing software including but not limited to grease boards and TPS system</li><li> Computer literate and very strong with Microsoft Office Suite.</li><li> Complete HBI revenue cycle classes within 6 months of hire date</li></ul>

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