COMPLIANCE SPECIALIST - Medicine and Radiology PB Coding

  • Requisition Number: 1475
  • Department: PRMO
  • Location: Durham
  • Type of Position: Regular
  • Apply

 

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.

 

Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire an experienced Compliance Specialist who will embrace our mission of Advancing Health Together.


Work Hours & Shifts
Full Time: Day Shift

Highlights:
* Career-forward opportunity with a nationally-ranked health system
* Quality of Life: Living in the Triangle
* Best in class benefit package
* Tuition Reimbursement for continuing education

Position Summary:
Compliance Specialist position reporting to Manager of PB Coding Operations - Medicine and Radiology that supports coding education and quality

• Coding Onboarding- (20%) – provide coding onboarding support to the Manager of PB Coding Operations - Medicine and Radiology
o Review of documentation guidelines for the coding of defined specialties for new employee/vendors or existing employees/vendors who are changing specialties
o Provide quality control review of onboarding cases and feedback to employee / vendor on a regular basis.
o Assist in onboarding new clinical sites including education on PRMO processes and coding guidelines

• Coding Quality Control (40%) – Processes/review coding related edits that support defined specialty areas in PB Coding Operations - Medicine and Radiology
o Review the coding of internal staff and external vendors on a monthly basis as a form of quality control
o Identification of coding and documentation trends for use in education of coding staff and providers
o Provide monthly QC report to Coding Manager including quality accuracy of coding staff members and  team results

• Coding Education (40%) - reviews charging / coding for defined specialty area and identifies trends that Manager / Supervisor will utilize in provide education
o Assist with research, development and presentation of continuing education programs on areas of specialization
o Review and disseminate Payer Bulletin updates and policy changes
o Provide education to coding staff/vendors and providers on a monthly basis including the coordination of Coding Newsletters with each specialty
o Maintain a thorough understanding of medical record practices, standards, regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc.

Education
Work requires organization, analytical and communication skills generally acquired through the completion of a Bachelor's degree program.

Experience
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 professional coding, specialty coding experience in Internal Medicine, Pediatrics, Radiology, Critical Care and E/M coding preferred.

Licensure/Certifications
CPC is required.

 

Duke University 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 essential job 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.