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.

The Compliance Specialist is responsible for evaluating, analyzing, and maintaining an accurate and meaningful Coding database for the hospital services, reflective of patient mix and resource use through monitoring of coding compliance in accordance with the Office of Inspector General's Work Plan, education, and internal audits.

Duties and Responsibilities of this Level 

• Educate providers regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and Fraud and Abuse with periodic updates.
• Assist in performing analysis of current situations and recommend priorities and goals for future clinic needs. Identify coding and billings risk areas, conduct focused reviews, and implement corrective action as needed.
  Conduct routine internal audits of provider documentation on a timely basis. 
• Collaborate with physicians and internal staff in the development of improved capabilities in the areas of documentation, coding, and compliance.
  Review internal controls, policies, and procedures to ensure compliance with appropriate University, State, and Federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives.
• Respond promptly to external and internal concerns; implementing corrective actions as appropriate.
  Communicate with Medicare/Medicaid Carriers and third-party payers regarding policies and procedures.
  Promote Compliance initiatives with clinical faculty and administration.
• Perform other related duties incidental to the work described herein.

Minimum Qualifications

Education

Work requires organization, analytical and communication skills generally acquired through the completion of a Bachelor's degree program.

Experience

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.

For technical coding, two of the four years of experience with DRGs and APR-DRGs is required. Experience in formal teaching of coding is preferred. RHIA or RHIT or CCS required.

For professional coding, specialty coding experience in surgical or E/M coding is preferred. CPC or CCS or RHIT or RHIA or CPMA is required.

Degrees, Licensure, and/or Certification

Knowledge, Skills, and Abilities

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 University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunities 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.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an 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.

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.

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 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.