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Patient Revenue Management Organization
Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.
Occ Summary
Perform medical and revenue audits to ensure revenue integrity as related to adherence to federal and state regulations, policies of external payers, and coding rules and guidelines. Exercise independent decisions using analytical and problem-solving skills. Provides critical analytical and negotiation support with respect to third-party payer reimbursement contracts.
Work Performed
Responsible for conducting quality control audits toensure data/documentation integrity and communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within the operational units. Serves as Subject Matter Expert to leadership on issues related to revenue integrity. Compile information and/or prepare reports and analyses setting forth results of data integrity findings with appropriate recommendations; perform subsequent audits to ensure complete and appropriate corrective action. Follow up with appropriate health team members to ensure accurate and complete documentation in the medical record. Works collaboratively with the appropriate operational leaders to develop provider education strategies to promote complete and accurate clinical documentation and correct negative trends and is able to impart this knowledge to providers and other health team members. Review payments for accuracy from contracted payers and management of the appeals process with each assigned payer in both the hospital and clinic settings. Provides critical analysis and negotiation on behalf of DUHS with respect to third-party payer reimbursement contracts. Perform other related duties incidental to the work described herein.
Knowledge, Skills and Abilities
In-depth knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements. Strong oral and written communication skills.
Level Characteristics
N/A
Minimum Qualifications
Education
Bachelor's degree in business administration, accounting, management, healthcare administration, nursing or other related degree.
Experience
3 years of experience related to auditing and/or coding is required. Clinical experience is preferred
Degrees, Licensures, Certifications
Coding certification (e.g. CCS, RHIA, RHIT) or applicable experience is preferred.
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
Originally posted on Himalayas