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.
Revenue Integrity Analyst (100% Remote) M-F
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; Pennslyvania; South Carolina; Tennessee; Texas; Virginia; or Washington, DC
General Description of the Job Class
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 independent decisions using analytical and problem-solving skills. Provides critical analytical and negotiation support concerning third-party payer reimbursement contracts.
Duties and Responsibilities of this Level
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. (20%)
Serves as Subject Matter Expert to leadership on issues related to Revenue Integrity (external medical audit request). (10%)
Compile information and/or prepare reports and analyses setting forth results of data integrity findings with appropriate recommendations; perform prospective audits to ensure complete and appropriate corrective action. (20%)
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 and service line education strategies to promote complete and accurate clinical documentation; using root cause analysis to correct negative trends, and behaviors and able to impart this knowledge to providers and other health team members. (20%)
Review charges and 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 concerning third-party payer reimbursement contracts. (20%)
Perform other related duties incidental to the work described herein. (10%)
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.
Nursing License 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.