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 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.

 

Duties and Responsibilities of this Level:

 

• 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 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 and other PRMO departments on Medicare rules and regulations related to charging and billing. Keep up-to-date on any regulatory changes and inform management in a timely manner.
• 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 providers and other health team members.
• Review charges and payments for accuracy from contracted payers.
• Analyze audit denial letters to determine reasons for denial and strategy for response.
• Formulate clinical argument as part of the formal appeals process supportive for appropriate reimbursement. 
• Determines the amount of charges, if any, to debit and credit the patients account, based on review findings.
• Provides critical analytical and negotiation on the interpretation of rules and regulations that are unclear on behalf of DUHS with respect to third party payer reimbursement contracts.
• Perform other related duties incidental to the work described herein.

 

Minimum Qualifications

 

Education
 

Bachelor's degree in business administration, accounting, management, healthcare administration, nursing or other related degree.

 

Experience

 

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.

 

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.