PRMO: , established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke PrimaryCare. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke's reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.
Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Revenue Integrity Analyst who will embrace our mission of Advancing Health Together .
Duties and Responsibilities of this Level:
Monitor data quality and optimal reimbursement to the hospital by performing concurrent and prospective quality reviews for accurate coding and sequencing of ICD-10-CM diagnoses and ICD-10-PCS or CPT-4 procedures (and appropriate use of modifiers) for inpatient and outpatient services using Center for Medicare and Medicaid coding guide lines, standards and regulations.
Interpret guidelines, applicable laws and regulations concerning hospital coding published in AHA Coding Clinic, AMA CPT Assistant, Federal Register, Medicare Bulletin, etc.
Develop and maintain specific coding guidelines for inpatient and outpatient coding.
Research problem areas and develop training material and coding aids for the coders.
Present timely, relevant educational programs to coding staff regarding coding updates, documentation and prospective payment system requirements.
Participate in training of the coders and evaluate the effectiveness of the training .
Maintain/update the coding compliance manual.
Monthly report on findings to coding staff and others (including Compliance Department).
Identify coding and billing risk areas for the hospital technical charges, conduct focused reviews, report the results, and implement corrective action as needed.
Serves as the technical expert for questions.
Conduct routine internal audits of coded data and physician documentation, report the results and recommend corrective action as needed.
Respond promptly to external audits and implement corrective action as appropriate.
Serve as a resource to the hospital on coding and documentation-related issues.
Educate physicians and other health care professionals regarding documentation requirements for accurate coding and reimbursement.
Educate Administration, Financial Management, Patient Resource Management, Revenue Managers, etc. regarding DRGs/APCs/A PR-DRGs and the reimbursement methodologies.
Collaborates with HB Coding, Billing, and others for process or system changes.
Participates in the creation and execution of educational initiatives associated with HIM strategies
Effectively communicates verbally and in written form, including provision of updates to Associate Director and Director regarding operation of work unit, project status, and staff issues.
Performs other related duties incidental to the work d escribed herein and performs other related work as required.
Bachelor's degree in business administration, accounting, management, healthcare administration, nursing or other related degree.
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.
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Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob 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.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.