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 Primary Care. 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 Dukeâ€™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 Nursing Highlights:
Duke University Health System is designated as a Magnet organization
Nurses from each hospitalare consistently recognized each year as North Carolina's Great 100 Nurses.
Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy for being strong advocates of specialty nursing certification.
Duke University Health System has 6000 + registered nurses
Quality of Life: Living in the Triangle!
This position may have an opportunity to work remotely. All Duke University remote workers must reside in one of the following states or districts: Arizona; California; Florida; Georgia; Hawaii; Illinois; Maryland; Massachusetts; Montana; New Jersey; New York; North Carolina; Pennsylvania; South Carolina; Tennessee; Texas; Virginia or Washington, DC
Occ Summary This position will be responsible for improving the overall quality and completeness of the medical record. Through interaction with physicians, nursing staff, medical records coding staff/compliance specialists, and other healthcare providers, they facilitate modifications to clinical documentation to ensure an accurate depiction of the level of clinical services, the reason for admission, patient severity, risk of mortality, the severity of illness and conditions present on admission. Reviews quality of medical record documentation and conveys deficiencies to house staff and attending physician. Compiles and documents chart findings in a dedicated CDI d database on a daily basis. Communicates with and educates members of the patient care team(physicians and advanced practice providers) and clinical documentation team on an ongoing basis. Participates in select committees and provides education programs as necessary.
This position may also be responsible for reviewing the overall quality and completeness of coding by reconciling differences in the MS-DRG assignment through comparison andanal ysis of the coding summary and CDI patient summary against medical record documentation. They utilize current CMS coding guidelines, conventions, and AHA coding clinics to accurately determine the principal and secondary diagnoses and procedures which affect the MS-DRGassignment. They also communicate with coders, compliance specialists, and/or clinical documentation analysts regarding documentation clarification and accurate coding. Work Performed Reviews clinical documentation and facilitates modifications, as needed, to ensure that documentation accurately reflects the reason for admission, the intensity of service rendered, risk of mortality, the severity of illness, and conditions present on admission for all patients, in compliance with government and other regulations. Maintains a system to identify discharges for chart review. Initiates chart review within 48-72 hours of identification. Notifies attending physician and house staff officers or other disciplines promptly of chart deficiencies requiring clarification, with a preference for face-to-face communication when practical.
Conducts follow-up reviews to ensure points of clarification have been addressed /recorded in the medical record and maintains an ongoing record of the results of each chart review including responses to each intervention. Serves as a resource to physicians and other members of the healthcare team in matters relating to published DRG, SOI/ROM, ICD-9, ICD-10, and PCS information. Maintains a level of practice demonstrating knowledge and understanding of AHIMA Practice Brief and knowledge of compliance and regulatory agency expectations. Compiles and provides timely entry to the CDI database for statistical reporting. Assists as necessary with a review of the medical record post-discharge to determine coding status. Completes timely retrospective review for unanswered queries (#NoResponse# queries). Reconciles DRG discrepancies collaboratively with HIM team to ensure an accurate compilation of codes sent to the fiscal intermediary. Maintains awareness of post-discharge charts being held for the completion of documentation deficiencies by the CDI department and is educated about the effect such charts have on AccountsReceivable (DNFB). Maintains a consistent plan for follow-up and completion on such charts. Facilitates ongoing education of staff in relation to chart documentation improvement techniques and practices. Provides periodic informal and formal in-service updates to medical staff and other disciplines on documentation issues using both one-on-one and group forums. Develops and disseminates approved documentation improvement literature. Works with medical records, finance, and physician groups to develop work systems to facilitate complete documentation for data reporting purposes. Evaluates variances in DRGs assigned by the CDI staff and collaborate with leadership across the System to support the educational needs of the CDI staff and Coders to ensure compliance with coding guidelines and identify opportunities for education.
Perform other related duties incidental to the work described herein. Knowledge, Skills, and Abilities Prio r Case Management / Utilization Review experience and/or training in advanced communication and interpersonal skills with all levels of internal and external customers. Excellent written/verbal communication, critical thinking, creative problem solving, and conflict management skills.Proficient organization and planning skills. Strong computer skills. Demonstrated knowledge of quality improvement theory and practice.
BSN or PA (Physician's Assistant) or NP (Nurse Practitioner) or Doctorate degree in a medically related field required.
Three years of progressive healthcare experience in an acute care setting. Previous chart review experience (case management utilization review) preferred. Excellent written/verbal communication, critical thinking, creative problem solving and conflict management skills in addition to proficient organization and planning skills required. Demonstrated knowledge of quality improvement theory and practice.
Degrees, Licensures, Certifications
Currently licensed and/or registered as a Professional Nurse/Physician Assistant/MD in the state of North Carolina, preferred. CCDS, CCS, or CDIP preferred.
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.
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.