Him Specialist Pfs Denial

OverviewKettering 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 OverviewKettering Health MiamisburgServing 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 facilityAwarded 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 & RequirementsJob Summary: HIM professional, ROI/PFS Denial Specialist, highly trained in Release of Information (ROI) functionality, along with Patient Financial Services (PFS) denials processing.
Provides the necessary medical documentation to support denial of claims for various insurance payors.
Skilled in working with EPIC applications, and in the electronic health record (EHR).
Required to work and manage the ROI Denial workqueues to meet quality and productivity standards.
Will be required to connect with department heads for both (ROI & PFS).
HIM Specialists affect the quality of patient information and patient care at every touch point in the healthcare delivery cycle.
They care for patients by caring for their medical data and are responsible for the quality, integrity, security, and protection of the patient's health information.
They are the link between clinicians, administrators, operations, and information technology professionals.Essential Functions:Collaborate with PFS staff to ensure timely processing of payor medical records requests.Monitor ROI/PFS work queues.Identify and report Payor medical records requests issues.Required attendance to Payor monthly meetings.Subject matter expert on required payor software programs utilized to upload records.Serve as the Liaison between Kettering Health and Payor Customer Service Representatives to onboard new electronic medical records processing software.Collaborates with Payor Customer Service Representatives to resolve denial trends.Analyze/reconcile weekly payor medical record request reports.Responsible for training additional Release of Information Staff to support Denial's process.Identify payor medical records denial trends and report to Revenue Cycle Leadership.Required to meet department standards for TAT for Payor medical record requests to ensure maximum reimbursement.Continually evaluates ROI/PFS workflows for continuous improvement opportunities.Maintain confidentiality of PHI in accordance with hospital policies and state/federal laws/regulations.Follow best practice protocols for disseminating confidential information and assuring the integrity of the clinical documentation released.Possess adaptability and flexibility for learning new concepts in patient accounts methodology.Job Requirements:Minimum Education: Associate degree in health information management by AHIMA or health-related field preferred, or a minimum of 2 years' experience in Release of Information department processing.
Experience in Revenue Cycle and billing setting preferred.Required Skills:Must possess excellent computer skills along with being proficient in EPIC EHR applications.Must demonstrate positive collaborative efforts in team building and engagement.Must embrace a continuous improvement environment.
This requires one to organize and prioritize work to meet quality and productive standards.Efficient in both KHMG and KH records processing.Supports patients' rights through maintaining confidentiality of patient medical information in accordance with hospital policies and State/Federal regulations.Must follow all HIPAA guidelines.Must demonstrate skills of planning, organizing, evaluating, improved "One Best Practices."
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