REVENUE INTEGRITY ANALYST
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 Revenue Integrity Analyst who will embrace our mission of Advancing Health Together.
- Performs medical chart audits to assess accurate patient class, utilization review outcomes, medical necessity/level of care in support of overturning insurance carrier denials.
- Initiates actions to obtain appropriate insurance adjudication decisions.
- Exercise independent decisions using analytical and problem solving.
- Audit and perform medical audits on denied accounts, determine appeal potential.
- Utilize Interqual and Milliman criteria to support accurate denial adjudication.
- Collaborate with Hospital UR/UM team to affect positive denial resolution.
- Prepare appeal letters and documentation packets to facilitate overturned denial decisions.
- Provide any needed documentation to justify appeals including but not limited to letters of medical necessity and case briefs outlining disposition reversal.
- Review write-off requests per policy.
- Provide feedback to management if case has potential for reimbursement via appeal or other process.
- Provide formal and informal education and feedback with other healthcare teams, revenue cycle to improve collections, reduce accounts receivable, reduce denial rates, and reduce avoidable write-offs through issue identification, research, communication, and process improvement.
- Follow up with appropriate healthcare team, to reduce denial rates and reduce avoidable write offs.
- Acts as a consultant/liaison to other PRMO teams when additional information or documentation is needed to resolve denied accounts.
- Assist with retroactive authorizations.
Bachelor's degree in business administration, accounting, management, healthcare administration, nursing or other related degree.
3 years of experience related to auditing and/or coding is required. Clinical experience is preferred
Degrees, Licensures, Certifications
Coding certification (e.g. CCS, RHIA, RHIT) or applicable experience is preferred.
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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.