Patient Revenue Management Organization
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.
General Job Description
Responsible for the oversight of all functions within the Coding Operation departments, including but not limited to providing support at the division level for daily departmental operations, reimbursement opportunities, and various programs. Serve as a member of the team; subscribe to the vision, values and expectations of the Duke University Health System.
Job Duties
Duties:
- Oversee Quality/Focused Audits for all PRMO Coding teams- PB and HB
- Act as contact and coordinator for organization auditing needs
- Identify areas for improvement and recommend solutions where education is needed for accurate coding and billing for both Hospital and Professional areas.
- Provide direction for department; Ensure TAT are met, QC of auditor QA, Ensure departmental integration, develop operational policies, procedures, standards and expectations, provide clear opportunities to meet or exceed objectives
- Assist with policy and procedure maintenance for coding and auditing functions
- Read and interpret LCD, NCD and other payer regulations and guidelines as related to coverage of services
- Interviewing, hiring, training employees, planning, assigning, and directing workflows, employee performance evaluation, proactively manage production and quality controls, resolving problems.
- Collaborate with other managers to ensure consistent implementation of coding policies, procedures and practice; maintain strong communications with director and peer managers
- Any/All other duties assigned by director
Knowledge, Skills and Abilities
Extensive knowledge of ICD-10-CM, PCS and CPT coding principal and guidelines. Extensive knowledge of hospital/technical and professional services reimbursement systems (DRGs, APCs, RBRVUs). Extensive knowledge of Federal, State and payer specific regulations and policies pertaining to documentation, coding, billing for technical and professional services, strong managerial leadership, and interpersonal skills. Excellent written and oral communication skills, excellent analytical skills.
Education Requirements / Preferences
BS Health Information Management, Health Informatics, Health Administration, Finance or related field. Master's degree in Business Administration or Health Administration is preferred
Experience Requirements / Preferences
Six years of experience in the healthcare industry is required, two of the six years are supervising or coordinating coding activities.
Licensure / Certification Requirements
Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT). Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) is a bonus.
Financial Responsibilities
Develop budget recommendations
Prepare budget requests and written narratives
Review expenses against budget
Supervisory Responsibilities
Duties: Compliance Specialist
Percentage of Time: 6
Working Conditions
Must be able to work under time pressures in a busy virtual office environment
Must be present on site for 8 hour shifts during standard business hours
Must participate in group activities requiring interpersonal skills and cooperation
Must work as later person when scheduled or according to business need
Must be able to react quickly and immediately respond to emergencies
Must travel between locations on a needed basis
Must be able to handle multiple assignments, conflicting demands and priorities
Must maintain attention to detail over extended period of time
Must be continually aware of variations in changing situations
Must be able to move throughout office environment throughout the day
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