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.
Responsible for the oversight of all functions within the CodingOperation 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.
Lead a growing Coding Audit (75%Professional and 25% Hospital) team that performs both prepayment and post payment reviews of medical records and claims
Provide insights and direction into operational processes and opportunities to improve efficiencies
Supervise and support the quality review process to evaluate coder effectiveness
Perform thorough and complex reviews of medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to PRMO.
Explicitly document findings including sources used to support decision making and in a way that can be easily understood by non-clinicians or coders.
Participate in educational calls or written communications to articulate findings.
Teams to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and improve the quality of physician documentation within the body of the medical record to support code assignments.
Communicate verbally and in written form the quality of other team members' coding audit reviews to ensure accuracy and compliance with coding standards and PRMO policy.
Review dashboards and interpret performance data to inform the Director of metrics before deadlines are missed.
Support Coding Quality Education (CQE) and Coding Leadership by monitoring and actively updating all operational hospital and professional coding policies to optimize the quality and accuracy of the coding services provided by hospital and professional coding staff.
Monitor and validate hospital soft coded/abstracted information for specific hospital patient types, and collaborate in providing education and/or training to coding staff on identified improvement areas.
Train new team members
Knowledge, Skills and Abilities:
Extensive knowledge of ICD-9-CM and CPT coding principles and guidelines. Extensive knowledge of hospital/technical and/or professional services reimbursement systems (DRGs, APCs, RBRVUs) Extensive knowledge of federal, state, and payer specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services, strong managerial leadership, and interpersonal skills, excellent written, oral and analyticlal skills.
Leadership skills/competencies such as building effective teams,cust omer focused, communicates effectively, collaborates, courage,decision quality, develops talent, drives engagement, ensures accountability, instills trust, emotional intelligence, and operational effectiveness.Maintains knowledge of applicable coding documentation and billing regulations re lated to Medicare, Medicaid, and commercial insurance.
BS Health Information Management, Health Informatics, Health preferred. Administration, Finance or related field. Master's degree in Business Administration or Health Administration is preferred.
Six years of experience in the healthcare industry is required, two of the six years are supervising or coordinating coding activities.
Degrees, Licensures, Certifications:
Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS), or Certified Professional Coder (CPC).
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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.