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.
The Compliance Specialist - Instructional Coordinator provides instruction that is fully available to medical coder trainees to ensure they are able to incorporate mandates in accordance with the Office of Inspector General's work plan, to reduce institutional and individual provider legal and financial risk through training and education. Additionally increase revenue, accuracy of payment and quality of care by identifying, training/educating and submitting unreported valid medical diagnosis and delegating diagnosis that were submitted inappropriately.
Duties and Responsibilities of this Level
Thorough understanding of clinic coding (E/M) documentation requirements and concepts
Ability to review documentation and abstract all codes with specific emphasis on identifying the most accurate severity of illness according to CMS and to provide education and training to medical coder trainees that will enable them to:
Leverage Healthcare Effectiveness Data and Information Set (HEDIS) to measure provider performance on important aspects of care and service.
Collaborate with CDI Representative to provide timely feedback that will assist with validating and reporting appropriate measures of accuracy.
Offers recommendations and develops templates and tips for training and education
Serve as a subject matter expert in conjunction with CDIS program lead(s) to providers, practice managers, PRMO leadership, and Duke Health stakeholders.
Coordinate activities related to Coding Quality Assurance training. Be actively engaged in coding, abstracting and medical data research to include review and analysis of data input, processing and data output activities in the medical coder trainee program.
Develop and present educational training programs to medical coder trainees.
Conducts both random and focused reviews timely for accurate coding by the medical coder trainees.
Identifies coding and billing risk area s and communicates timely through the appropriate channels/forums those areas that require escalation. And shares this information with the medical coder trainees.
Collaborates with internal staff in development of improved capabilities in coding and compliance to utilize with the medical coder trainees.
Responds promptly to external and internal concerns with regard to correct coding policies. Identifies errors made by medical coder trainees to ensure better understanding and implementation on future coding efforts.
Assists with education of medical coder trainees in regard to compliance and government regulations with special attention to CMS and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and Fraud and Abuse with periodic updates.
Maintains knowledge regarding policies and procedures with Medicare/Medicaid Carriers and third party payers sharing that information with the medical coder trainees.
Collaborates with Internal Compliance Department to promote excellence in correct documentation and coding instruction offered to the medical coder trainees.
Interacts effectively and professionally with colleagues to provide helpful information in response to inquiries, concerns and request s related to the training program.
Develops and maintains strong working relationships with both internal and external customers .
Provides documented education (i.e. PPT, handouts, training materials, etc . to be posted to the Quality Audit/Review Share Point) and tracks the individual educational opportunities afforded the medical coder trainees.
Provides daily on site educational sessions with evaluations of the medical coder trainees post training.
Assists in the financial goals of the department through individual efforts as well as encouraging excellence in the medical coder trainees.
Adheres to all internal policies.
Actively promotes a better DUHS work environment an d a positive atmosphere in which to work.
Exemplifies DUHS core values and encourages others to follow this high stander.
Shows respect and values others at all times.
Participates in multiple employee engagements that align with covenant mission
Performs other duties as assigned by management
Performs other related duties incidental to the work described herein:
Maintains all coding credentialing that includes CPC, CPMA, CCS and other training certifications and education.
May participate in payer testing.
May work with HLI staff and DUHS IT staff to provide data analysis.
May work collaborative with IMO/MC teams to identify critical language/coding needs.
Anticipates needs of DUHS regardingI-9/I-10 data analytics, preference list and mappings/crosswalks.
Work requires organization, analytical and communication skills program, generally acquired through the completion of a Bachelor's degree.
**Bachelors degree strongly preferred.
Certified AHIMA ICD-10 Trainer or other demonstrated training experience highly preferred.
Requires four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle related functions. For technical coding, two of the four years of experience with DRG's and APR-DRG's is required. Experience in formal teaching of coding is preferred. RHIA or RHIT or CCS required. For professional coding, specialty coding experience in surgical or E/M coding preferred. CPC or CCS or RHIT or RHIA or CPMA is required.
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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.
Patient Revenue Management (PRMO)
Internal Number: 10948
About Duke University Health System
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.