The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children’s Hospital, Where Passion Meets Purpose.
Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission.
We’re 14,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we’ll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.
Ask anyone with a Nationwide Children’s badge what they do for a living. They’ll tell you it’s More Than a Job. It’s a calling. It’s a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.
Nationwide Children’s Hospital. A Place to Be Proud.
Responsibilities
Manage coding, auditing, and billing initiatives and projects. This will include knowledge and reconciliation of critical patient claims data, physician documentation, and billing audits in order to develop performance improvement plans and implement agreed upon interventions in the above-mentioned areas.
Pulls, analyzes, and compiles large data sets for reporting and budgeting as related to projects and financial management activities.
Manages payor enrollment and termination process, sends packets to health plans, and does appropriate follow-up. Collaborates to ensure providers are actively enrolled with contracted health insurance companies and maximizes use of online applications to expedite processing time. Works with external payor enrollment personnel to provide direction and information as needed.
Monitors updates, coordinates patient reports, maintains tracking system, and collaborates across areas to ensure a stream-lined approach and timely billing of patient accounts, coordinated audits, and reconciliations. Coordinates the review, revision, and maintenance of business and legal documents.
Educates providers regarding the processes of registering with the Federal Credential Verifications Services, obtaining Ohio medical license/DEA, and obtaining Medical Staff privileges.
Coordinates validation of Council for Affordable and Quality Healthcare (CAQH) profile for each physician every 90-120 days and uploads certifications quarterly. Annually uploads liability information on all providers and maintains a file of all relevant payor enrollment-related information for each physician, including current Curriculum Vitals and skill-set certifications.
Enrolls pathologists in SharePoint for enrollment process and monitors all status updates. Tracks the following items: status level of privileges at NCH and other hospitals, malpractice coverage history for each physician, and status of enrollment with various payors.
Coordinates the activation of malpractice coverage alongside NCH Legal Services once a physician is hired, orients new pathologists on procedures of reporting malpractice related information, and provides malpractice carrier history and contact information as needed. Serves as a reporting resource for potential malpractice suits and requests malpractice coverage letters for pathologists when applicable.
Qualifications
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
Bachelor degree in business, health care administration preferred; or equivalent professional experience in professional billing. Certified Professional Biller or Coder Preferred
Excellent communication skills, both verbal and written, as well as strong organizational and analytical abilities to identify opportunities and solutions for process improvement and implement those solutions.
Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
Ability to work with highly confidential information under minimal supervision.
Ability to research, analyze data, organize, and prioritize work, and manage multiple priorities.
Basic typing skills and working knowledge of Microsoft Office Applications.
Knowledge of various organizations and database used in payor enrollment and hospital credentialing, including CAQH?s Universal Provider Database, FCVS, State Licensing Boards, and skill-set certifications.
Minimum of 2-3 years professional billing experience
One year of provider payor enrollment, preferred.
Knowledge of medical terminology, various claim forms, third party contracts and payment patterns, CPT and ICD10 coding, and reimbursement regulations and policies of third party payers.
Experience with credentialing software programs, preferred.
