PATIENT ACCOUNT ANALYST - AMBULATORY DOCUMENTATION AND CODING
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.
Underthe direction of the Ambulatory Documentation and Coding O perations (ADCO)manager, the Risk Adjustment Analyst is responsible for coordinating, preparingand analyzing risk adjustment data, productivity reporting and compiling datafrom various quality programs and organizati onal initiatives as required. . Theanalyst will work collaboratively wit h other departments across DUHS lines ofbusiness to ensure integrity of data. Reviewand analyze trends, advising PRMO, DUHS and PDC leadership regardingconclusions and recommendations.Serve as expert resource for covered area.The Ri sk AdjustmentAnalyst is integral to the success of the Duke University H ealth System’s AmbulatoryDocumentationand Coding Initiative (ADCI) stra tegic and operational goals. Asan expert on data analysis, the incumbent will be responsible for (1) theidentification, analysis, and interpreta tion of EMR, payor, and other datasources to support program evaluation; (2) guide analyses and decision makingaround continuous quality improve ment activities; and (3) producing reports tosummarize findings, support program decisions and meet deliverables. This position requires an ana lyst intriguedand driven by the challenge of creating information from d ata; skilled at organizingthe presentation of quantitative information t o facilitate understanding andilluminate decision making.
Duties and Responsibilities o f this Level
1. Reporting and Analysis: Work intan dem with the Population Health Management Office- Risk Adjustment andExp erience unit, including the actuarial team, to develop reporting and key metrics to help support coding educational programs. Analyze plan inform ationand data collection for Risk Adjustment utilizing advanced querying techniques.Prepare written reports for PRMO, DUHS and PDC leadership hi ghlighting trendsand appropriate recommendations/conclusion s. (30%)
2. Data Quality Assurance: Workwith PHMO Data & Analytics and IT teams to develop and implement anappro priate quality acceptance testing and validation strategy to ensurecompl eteness and accuracy of data. Performroot cause analysis of changes or issues with data quality, and takeappropriate steps to effect resolution /explanation of any variances. Ensuremodels are running appropriately an d any model updates or changes are incorporatedinto our educational prog ramsand coding workflows. (15%)
3. Communication: Maintai n liaisonwith DUHS, PRMO and PDC management and staff, documenting repor ts and analyses and discussing results,trends and recommendations. Organizeand lead committee meetings as it relates t o Ambulatory Documentation andCoding initiatives. Communicate informatio n effectively and present analyticalfindings in a variety of formats (re ports, PowerPoint, Tableau, graphs,figures, and tables). (15%)
4. Customer Service: Act as atechnical resource to operational mana gement and internal and vendor supportstaff on the appropriate interpret ation ofkey performance indicators (KPI) and metrics. Coord inate and mentor internaland vendor support staff regarding KPIs andfina ncial systems, analyses, reports and policies/procedures.Wo rk with users to identify reporting needs, define report criteria and pr oducereports that help guide business decisions. Maintain impeccable com municationwith internal and external stakeholders regarding the developm ent status ofwork requests. (15%)
5. Process Improvement: Identifyprocess improvements, including staff education/tra ining, operational workflow modifications, systemenhancemen ts, system testing and policy changes. Plays an integral role in change management and works withappropriate personnel to implement improvements. Develops predictive models andother tools that help with prioritization and workflow. (10%)
6. Profes sional Growth andDevelopment: Maintain current knowledge of trends, regu lations and technologyrelated to coding, reimbursement and clinical docu mentation throughprofessional journals, informal networks, internet site s and local, state, andnational professional associations. Maintain know ledge of industry standardsfor metrics and analyses in a value-based pay ment healthcare environment. (10%)
7. Perf ormother related duties incidental tothe work described he rein. (5%)
Bachelor's Degree in business, healthcare administration, accounting, finance or a related field is required
Minimum of four years of applicable experience. Previous experience successfully managing complex projects involving multiple stakeholders with a consistent track record of delivering on time, or high quality results preferred. A Master's degree in a related field can substitute two years of experience on a 1:1 basis.
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