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REVENUE INTEGRITY ANALYST - Charge Integrity

Company: Duke Health
Location: Durham
Posted on: May 23, 2020

Job Description:

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. --General Description Promotes charge capture accuracy requiring a full understanding of the revenue management functions. Responsible for collaborating with PRMO Revenue Managers to ensure accurate and through high level analysis of Governmental and commercial payer regulations related to authorization and billing guidelines. Will maintain current knowledge regarding changing regulations, billing/charging and regulatory agency activities. Provides critical analytical and negotiation support with respect to third party payer reimbursement contracts.--Duties and Responsibilities Responsible for serving as the principal agent/liaison regarding Payor guidelines, explaining regulatory requirements, and overseeing the Payor Relations accountability process for Revenue and Documentation Integrity. ----Serves as Subject Matter Expert to DUHS leadership on issues related to Revenue Integrity; CMS and Commercial payer reimbursement guidelines.--Review payments for accuracy from contracted payers in both the hospital and clinic setting. Attend high-dollar account conversations with stakeholders, serving as subject matter expert for ensuring claims pay appropriately.--Perform other related duties incidental to the work described herein.----Required Qualifications Education:--Bachelor's degree in business, healthcare administration, or other related field is required.--Experience: 3 years of experience related to auditing and/or coding is required.-- Clinical experience is preferred.Degrees, Licensure, and/or Certification: --Coding certification (e.g. CCS, RHIA, RHIT) or applicable experience is preferred.Knowledge, Skills, and Abilities:-- In-depth knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements.Strong oral and written communication skills---- 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.

Keywords: Duke Health, Durham , REVENUE INTEGRITY ANALYST - Charge Integrity, Professions , Durham, North Carolina

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