340B Health
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Overview Duke Health’s Patient Revenue Management Organization is a fully integrated, centralized revenue cycle organization that supports the entire health system. It streamlines scheduling, registration, coding, billing, and other essential revenue functions.
Responsibilities
Implement and maintain compliance programs in accordance with the Office of Inspector General’s work plan, reducing institutional and individual provider legal and financial risk.
Educate providers on compliance with government regulations, emphasizing Center for Medicare & Medicaid guidelines, HIPAA, and Fraud & Abuse; provide periodic updates.
Assist in analyzing current situations and recommend priorities and goals for future clinic needs.
Identify coding and billing risk areas, conduct focused reviews, and implement corrective action as needed.
Conduct routine internal audits of provider documentation on a timely basis.
Collaborate with physicians and internal staff in developing improved capabilities in documentation, coding, and compliance.
Review internal controls, policies, and procedures to ensure compliance with university, state and federal guidelines and sound business practices.
Respond promptly to external and internal concerns; implement corrective actions as appropriate.
Communicate with Medicare/Medicaid carriers and third‑party payers regarding policies and procedures.
Promote compliance initiatives with clinical faculty and administration.
Knowledge, Skills & Abilities
Strong knowledge of Medicare & Medicaid guidelines (academic medical centers), HIPAA, and Fraud & Abuse regulations.
Ability to analyze complex coding and billing documents and identify risk areas.
Proficiency in conducting internal audits and developing corrective action plans.
Excellent communication skills for collaborating with physicians, staff, and payers.
Ability to promote compliance initiatives and train clinical faculty.
Requirements
Education: Bachelor’s degree required. Some experience in organizing analytical and communication skills is essential.
Experience: Four years of administrative experience applying compliance, coding and auditing principles to insurance billing, collections, consulting, or other revenue‑cycle functions. Two of those years should involve DRG or APR‑DRG coding. Formal teaching of coding is preferred.
Certifications: RHIA, RHIT, or CCS required. For professional coding, specialty coding experience in surgical or E/M preferred. CPC, CCV, RHIT, RHIA, or CPMA required.
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 a provision for requests for reasonable accommodation will be provided by each hiring department.
Equal Opportunity Employment Duke is an 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 (including pregnancy and pregnancy related conditions), sexual orientation or military status.
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Overview Duke Health’s Patient Revenue Management Organization is a fully integrated, centralized revenue cycle organization that supports the entire health system. It streamlines scheduling, registration, coding, billing, and other essential revenue functions.
Responsibilities
Implement and maintain compliance programs in accordance with the Office of Inspector General’s work plan, reducing institutional and individual provider legal and financial risk.
Educate providers on compliance with government regulations, emphasizing Center for Medicare & Medicaid guidelines, HIPAA, and Fraud & Abuse; provide periodic updates.
Assist in analyzing current situations and recommend priorities and goals for future clinic needs.
Identify coding and billing risk areas, conduct focused reviews, and implement corrective action as needed.
Conduct routine internal audits of provider documentation on a timely basis.
Collaborate with physicians and internal staff in developing improved capabilities in documentation, coding, and compliance.
Review internal controls, policies, and procedures to ensure compliance with university, state and federal guidelines and sound business practices.
Respond promptly to external and internal concerns; implement corrective actions as appropriate.
Communicate with Medicare/Medicaid carriers and third‑party payers regarding policies and procedures.
Promote compliance initiatives with clinical faculty and administration.
Knowledge, Skills & Abilities
Strong knowledge of Medicare & Medicaid guidelines (academic medical centers), HIPAA, and Fraud & Abuse regulations.
Ability to analyze complex coding and billing documents and identify risk areas.
Proficiency in conducting internal audits and developing corrective action plans.
Excellent communication skills for collaborating with physicians, staff, and payers.
Ability to promote compliance initiatives and train clinical faculty.
Requirements
Education: Bachelor’s degree required. Some experience in organizing analytical and communication skills is essential.
Experience: Four years of administrative experience applying compliance, coding and auditing principles to insurance billing, collections, consulting, or other revenue‑cycle functions. Two of those years should involve DRG or APR‑DRG coding. Formal teaching of coding is preferred.
Certifications: RHIA, RHIT, or CCS required. For professional coding, specialty coding experience in surgical or E/M preferred. CPC, CCV, RHIT, RHIA, or CPMA required.
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 a provision for requests for reasonable accommodation will be provided by each hiring department.
Equal Opportunity Employment Duke is an 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 (including pregnancy and pregnancy related conditions), sexual orientation or military status.
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