What are the responsibilities and job description for the REVENUE INTEGRITY ANALYST position at Duke?
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.
Duties and Responsibilities of this Level:
A. Monitor data quality and optimal reimbursement to the hospital by performing concurrent and prospective quality reviews for the accurate coding and sequencing of ICD-10-CM diagnoses and ICD-10-PCS or rCPT-4 procedures (and appropriate use of modifiers) for inpatient and outpatient services using Center for Medicare and Medicaid coding guidelines, standards and regulations.
35% of the time spent
- Interpret guidelines, applicable laws, and regulations concerning hospital coding published in AHA Coding Clinic, AMA CPT Assistant, the Federal Register, Medicare Bulletin, etc. Develop and maintain specific coding guidelines for inpatient and outpatient care. Research problem areas and develop training materials and coding aids for the coders.
- Present timely, relevant education programs to coding staff regarding coding updates, documentation, and prospective payment system requirements. Participate in the training of the coders and evaluate the effectiveness of the training.
- Maintain or update the coding compliance manual.
- Monthly report on findings to coding staff and others (including the Compliance Department).
B. Identify coding and billing risk areas for the hospital technical ch charts, conduct focused reviews, report results, and implement corrective action as needed 30% of time spent
- Serves as the technical expectation for questions
- Report the results and recommend corrective action as needed. Conduct routine internal audits of coded data and physician documentation.
- Respond promptly to external audits and implement corrective action as appropriate.
C. Serve as a resource to the hospital on coding and documentation-related issues. Educate physicians and other healthcare professionals regarding documentation requirements for accurate coding and reimbursement. Educate administration, financial management, revenue managers, etc. regarding DRGs, APCs, and APR-DRGs and the reimbursement methodologies.
30% of time spent
- Collaborates with HB Coding, Billing, and others for process or system changes.
- Participates in the creation and execution of educational initiatives associated with HIM strategies.
- Effectively communicates verbally and in written form, including provision of updates to the Associate Director and Director regarding the operation of the work unit, project status, and staff issues
D. Other: 5% of time spent
performs other related duties incidental to the work described herein and performs other related work as required
Minimum Qualifications
Education
Bachelor's degree in business administration, accounting, management, healthcare administration, nursing, or another related degree.
Experience
3 years of experience related to auditing and/or coding is required. Clinical experience is preferred
Degrees, licenses, and 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.
