Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.

Occ Summary

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.

Work Performed

Coding Activities - Oversee coding operations for designated areas of responsibility to ensure assignment and timely management of uncoded accounts. - Act as contact and coordinator for organization coding needs - Maintain routine touch points and monitoring of coding activities with coding team and business partners. - Research coding questions and provide coder feedback. - Ensure timely correction of coding errors and edits - Ensure participation by all coders in education opportunities and develop education where needed. - Identify areas where education to improve complete and accurate coding and billing in compliance with the Professional and hospital systems. - Ensure coding audits are performed concurrently and that the areas being audited are updated in conjunction with the department policies. - Keep abreast of regulatory changes related to coding and documentation and communicate these changes to appropriate corporate and hospital staff. - Oversee management of the coders to ensure turnaround time commitments are met - Support Coder Education initiatives toinclude post-audit, new coder, transition coder, and electronic coding systems. - Assist with policy and procedure maintenance for coding functions. - Read and interpret Local Coverage Determinations, National Coverage Determinations and other payer regulations and guidelines as related to coverage of services. Leadership Activities - Provide direction for the division -

Ensure that audit reports are reviewed, accurate, and corrective action plans implemented - Promote and emulate a patient-centric and customer service focus within the division. - Ensure the division is integrated with other departmental areas. - Interacts regularly with physicians, leadership and other associates to ensure compliance and accuracy of coded information. - Develop the division's operational policies, procedures standards and expectations, providing clear opportunities to meet or exceed the entity balanced scorecard objectives. - Conduct performance reviews of direct reports; develop and mentor direct reports and staff. - Responsibilities include interviewing, hiring and training employees; planning, assigning and directing workflow, appraising employee performance; addressing complaints and resolving problems; and proactively managing production and quality control efforts.- Collaborate with other coding managers to ensure consistent implementation of coding policies, procedures, and practice - Maintain strong communication with Director(s) and business partners in reporting of unbilled activities related to coding - Schedule regular staff meetings for updates, new policies, education, open discussion related to healthcare, diversity, training, encouraging positive work environment. Financial Activities - Acts as an internal and external expert in various reimbursement methodologies. - Responsible for the financial, service and productivity performance of the division. - Develop the departmental operating budget and goals. - Proactively monitor, analyze and manage reports and all related documents - Ensure an effective data collection and processing system by reviewing and analyzing data input, processing and data output activities. Perform audits to evaluate the quality and timeliness of coding and abstraction of charges. - Ensure the accuracy, completeness, and timeliness of case processing activities within the major work unit supervised. - Actively participate in the Internal Audit Process exit conferences, providing clarification and supporting information necessary. - Monitor, verify and reconcile expenditures of budgeted funds, compiling information reflecting expenditures, and develop cost- comparisons. - Identify cost savings within the operation. Perform other related duties incidental to the work described herein.

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 and oral communication skills; and excellent analytical skills

Level Characteristics

Leadership skills/competencies such as building effective teams, being customer-focused, communicating effectively, collaborating, courage, decision quality, developing talent, driving engagement, ensuring accountability, instilling trust, emotional intelligence, and operational effectiveness. Maintains knowledge of applicable coding documentation and billing regulations related to Medicare, Medicaid, and commercial insurance.

Minimum Qualifications

Education

BS Health Information Management, Health Informatics, Health Administration, Finance or related field. A master's degree in business administration or health administration is preferred.

Experience

Six years of experience in the healthcare industry are 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).