REVENUE INTEGRITY ANALYST-100% Remote

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

About Duke Health's Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's 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.

This position may have an opportunity to work remotely. All Duke University remote workers must reside in one of the following states or districts: Arizona; California; Florida; Georgia; Hawaii; Illinois; Maryland; Massachusetts; Montana; New Jersey; New York; North Carolina; Pennsylvania; South Carolina; Tennessee; Texas; Virginia or Washington, DC

General Description of the Job Class

Perform medical and revenue audits to ensure revenue integrity as related to adherence to federal and state regulations, policies of external payers, coding rules and guidelines. Exercise independent decision-making using analytical and problem-solving skills. Provides critical analytical and negotiation support with respect to third-party payer renewal contracts.

Duties and responsibilities of this Level

Responsible for conducting quality control audits to ensure data and documentation integrity, communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within the operational units. (20%)

Serves as a subject matter expert to leadership on issues related to revenue integrity (external medical audit request). (10%)

Compile information and/or prepare reports and analyses setting forth the results of data integrity findings with appropriate recommendations; perform prospective audits to ensure complete and appropriate corrective action. (20%)

Follow up with appropriate health team members to ensure accurate and complete documentation in the medical record. Works collaboratively with the appropriate operational leaders to develop provider and service learning education strategies to promote complete and accurate clinical documentation, using root cause analysis to correct negative trends and behaviors, and is able to impart this knowledge to providers and other health team members. (20%)

Review charges and payments for accuracy from contracted payers and manage the appeals process with each appointed payer in both the hospital and clinic settings. Provides critical analysis and negotiation on behalf of DUHS with respect to third-party payer reimbursement contracts. (20%)

Perform other related duties incidental to the work described herein. (10%)

Bachelor's degree in business administration, accounting, management, healthcare administration, nursing or another related degree.

3 years of experience related to auditing and/or coding is required. Clinical experience is preferred

Coding certification (e.g., CCS, RHIA, RHIT) or applicable experience is preferred.

Duke 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 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.