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 an experienced Revenue Integrity Analyst who will embrace our mission of Advancing Health Together .
Perform medical and revenue audits to ensure revenue integrity as related to adherence to federal and state regulations: policies of external payers, coding rules and guidelines. Exercise in dependent decisions using analytical and problem solving skills. Provides critical analytical and negotiation support with respect to third party payer reimbursement contracts.
Responsible for conducting quality control audits to ensure 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 provide and other health team members.
Review payments for accuracy from contracted payers and management of appeals process with each assigned payer, in both the hospital and clinic setting.
Provides critical analytical 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.
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.
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