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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 Primary Care. 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 Dukeâ€™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.
Manager of Coding Operations *(over the Revenue Integrity Team)
This position may have an opportunity to work remotely. All Duke University remote workers must reside in one of the following states or districts: Arizona; California; Florida; Georgia; Hawaii; Illinois; Maryland; Massachusetts; Montana; New Jersey; New York; North Carolina; Pennsylvania; South Carolina; Tennessee; Texas; Virginia or Washington, DC
Oversee coding operations as they relate to Revenue Integrity including the assessment of appropriate coding, documentation, and charging of audited encounters. Supervises and directs the quality review and internal control process to evaluate coding, documentation, and billing effectiveness. Maintain routine touchpoints and monitoring of coding and charging activities through collaboration with Intact Teams. Responsibilities include oversight and analysis of significant coding RACs that have been transferred from the coding department to Revenue Integrity. Medicare changes that now require front door edits, that prevent billing of high-dollar ICD10/DRGS – requiring the Revenue Integrity group to perform coding review and analysis of these encounters before being released for billing. Research coding questions that arise from pre and post-payment payor audits or insurance defense audits. Provide insights and direction into operational processes and opportunities to improve efficiencies. Using clinical coding expertise, collaborate with inpatient and outpatient coding teams and clinical teams to address coding and documentation concerns and to ensure timely correction of coding errors and edits. Ensures ongoing team-wide participation in coding education where appropriate. Identify areas for education to improve complete and accurate coding and billing in compliance with Professional and Hospital Systems. (30%)
Establish and maintain the Revenue Integrity department to support DUHS, including metrics, policies and procedures, monitoring programs, and education initiatives. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing workflow, appraising employee performance; addressing complaints and resolving problems; supervising and assessing contractor performance, and proactively managing production and quality control efforts. Ensure the division is integrated with other departmental areas. Interacts regularly with physicians, leadership, and other associations to ensure compliance and accuracy of coded and billing information. (20%)
Identify, develop, implement and maintain operating procedures, which are consistent with effective internal control practices, compliance standards, and institutional policies. Responsible for ensuring quality, timely production, and resolution of external audit reviews (CMS, QIO, Managed Care, and other Payors) that impact institutional and professional Coding/Charge Capture/CDM (NCD-LCD) and Billing/Follow up services; reporting appropriately. Explicitly document findings including sources used to support decision-making, utilizing methods that can be easily understood by non-clinicians or coders. (15%)
Develop fully functional operating budget(s) to meet system goals. Responsible for the financial, service, and productivity performance of the departments' associates, overseeing hiring, orientation, and development of new employees, assigning work, and conducting performance evaluations. (10%)
Oversee data analysis, trending, and management reporting to substantiate positive, compliant net revenue impact from the core functional areas; presenting opportunities to improve reductions in probes, denials, and avoidable write-off measures. Identify issues and/or enhancements for the operating tools utilized by team members. (10%)
Promote and emulate an integrated patient-centric and customer service focus within the department through collaborative strategic relationships with finance, Utilization, and Case Management HIM, Coding Operations, Professional and Technical Billing and DUHS/PDC Compliance, CDM, Revenue Management, and applicable vendors (5%)
Prepare and consistently evaluate work measurement criteria and manage enforcement of performance standards; with the ability to implement necessary reassignment and changes effectively; performing daily audits (5%)
Perform other duties, responsibilities, and activities as assigned at any time to meet DUHS demands (5%)
BS Health Information Management, Health Informatics, Health preferred. Administration, Finance, or related field. A Master's degree in Business Administration or Health Administration.
A BS in Nursing with a coding certification is desired.
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), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC).
EPIC certification desired.
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.
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.