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.
General Description of the Job Class
Implement and maintain Compliance programs in accordance with the Office of Inspector General's work plan, to reduce institutional and individual provider legal and financial risk through education and internal audits.
Duties and Responsibilities of this Level
Educate providers, HIM Coders and Strategic Customers (inclusive of vendors, CDI, and DUHS affiliates) with regard to the best practices for inpatient and outpatient Coding and Billing and documentation according to and in compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines, HIPAA, and Fraud and Abuse with periodic updates around AHA (America Hospital Association) standards. (30%)
Assist in performing analysis of current situations and recommend priorities and goals for future HIM coding needs. Identify coding and billing risk areas, conduct focused reviews, and implement recommended action plans and education as needed. (20%)
Assist in the coordination of Technical Coding Integrity QA staff by engaging in HIM coding, abstracting and medical data research to include review and analysis of data inputs, processing and data output activities. Develop and present workflow enhancement opportunities and participate in educational training programs to Hospital and Duke Staff. (30%)
Evidence Based Medicine considerations and "Best HIM Coding and Documentation practices" to effectively minimize the Duke organizational exposure to risk, by following the DUHS Corporate Compliance-PRMO policies and procedures and any other governing regulations.
Serving as Coding Integrity Technical QA point of contact/liaison for hospital coding, documentation and billing related needs
Conducting meetings, providing agenda items, fostering team work and cooperation, organizing team functions
Serving as primary technical resource for team members, providing training and guidance to team for issue resolution
Ensuring that Internal and External contracting of vendors meet requirements outlined by PRMO, DUHS Corporate Compliance and are followed in the initiation and execution of HIM Coding controlling standards
Review Auditing and tracking of monthly Coding Integrity Technical QA audit results and opportunities for improvements
Assist in performing analysis of current situations and recommend priorities and goals for future coding educational needs. Identify coding and billings risk areas, conduct focused reviews, and implement education actions as needed with internal and external stakeholders
Conduct routine internal audits of HIM coder's findings on a timely basis. Collaborate with HIM leaders, coders, and any internal staff in development of improved capabilities in the areas of documentation, coding, and compliance
Review internal controls, policies, and procedures to ensure compliance with appropriate coding guidelines, that create a defensible HIM billing, coding and documentation environment which supports industry best practices
Respond promptly to external and internal concerns; implementing research and educational actions- as appropriate
Use the established measurement tools to assess execution of necessary internal controls are adhered and leverage virtual remote capabilities for productive work
Maintain liaison with internal and external stakeholders to advise units regarding best practices for HIM coding, documentation and billing matters. Effectively communicate with directors and managers to determine needs to ensure accurate and informed HIM coding decision-making. Performing other duties as assigned (20%)
Required Qualifications at this Level
Work requires organization, analytical and communication skills generally acquired through the completion of a Bachelor's degree program which is preferred.
Four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle related functions.
Degrees, Licensure, and/or Certification:
For technical coding, two of the four years of experience with MS-DRGs and APR-DRGs is required. Experience in formal teaching of coding is preferred. RHIA, RHIT, or CCS required. CPMA Preferred.
Knowledge, Skills, and Abilities:
Proficient in the use of Microsoft Office Programs, including but not limited to: Excel, Word, PowerPoint, and Access.
Knowledge of EPIC preferred.
Extensive knowledge of ICD-10 Coding Guidelines, CPT/HCPCS, MS-DRGs/MCC/CC, Revenue Coding, modifiers, billing regulations and APCs.
Must have an ability to establish relationships with related areas such as the Clinical Documentation Improvement, Auditing and Revenue Integrity
Knowledge of clinical settings and applications
Ability to research complex coding and regulatory requirements through strong analytical skills.
Distinguishing Characteristics of this Level
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Duke is an Affirmative Action/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, sexual orientation, or veteran status.
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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.