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revenue integrity analyst - Durham, United States - Dukehealth
Description
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
About Duke Health's Patient Revenue Management Organization
Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.
100% Remote
General Description of the Job ClassReady to apply Before you do, make sure to read all the details pertaining to this job in the description below.
Responsible for reviewing accounts captured by revenue guardian edits and applying appropriate charge codes dependent upon medical documentation. Critical thinking and analysis to determine best approach for launching new edits to minimize revenue leakage. Exercise independent decision-making using analytical and problem-solving skills. Provides critical analytical and negotiation support with respect to third party payer reimbursement contracts.
Duties and Responsibilities of this Level
Responsible for conducting quality control audits to ensure data/documentation integrity, and the trending of accounts that qualify for revenue guardian edits. This includes compilation by the clinical department for education deliverables.(20%)
Serves as Subject Matter Expert to leadership on issues related to Revenue Integrity. (10%)
Preparation of monthly reports and educational presentations for clinical departments and Revenue Manager teams. Compilation of data trends will be monitored to validate documentation improvement initiatives and optimizing charge capture activities. (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, behaviors and able to impart this knowledge to provider 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. Identify revenue gains (gross dollars/percentage for net) through various reporting tools. (20%)
Perform other related duties incidental to the work described herein. (10%)
Required Qualifications at this Level
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. Reporting and analysis experience is preferred.
Degrees, Licensure, and/or Certification: Coding certification (e.g. CCS, RHIA, RHIT) or applicable experience is required.
Knowledge, Skills, and Abilities: In-depth knowledge of Medicare/Medicaid regulations, including billing, coding, and documentation requirements.
Strong oral and written communication skills.
Research oriented with the ability to critically analyze and reason large amounts of data
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.
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