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Posted: 28-Feb-25
Location: Durham, North Carolina
Categories:
Internal Number: 254956
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.
General Description of the Job Class
Coordinate/review the work of vendor outsourcing partners and assist with the training and continuing education programs. Code medical records utilizing ICD-9-CM/ICD-10CM and CPT-4 coding conventions. Review the medical record to ensure specificity of diagnoses, procedures, and appropriate/optimal reimbursement professional charges. Abstract information from medical records following established methods and procedures.
Duties and Responsibilities of this Level
· Ensure quality and quantity of work performed through regular audits and Quality Control for vendor services, specifically in the area of Coding Denials and Appeals
· Monitor and track outsourcing vendor performance as it pertains to Quality Control, Productivity, and Process Improvement
· Be able to manage multiple Vendor coding WQ by ensuring account prioritization while establishing outsourcing accountability
· Be able to initiate, lead, and follow through on the completion of any special projects assigned to the Vendor Services
· Be able to work Coding Denials WQ and submit appeals and documents associated with the process.
· Review and review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10 CM and/or CPT, HCPCS coding conventions, and payer-specific coding guidelines.
· Develop and assist training, presentations, and educational materials for any relevant topic as it relates to continuing education programs in areas of specialization, coding, operational workflow, and quality control.
· Collaborates with other departments and partners (e.g. Revenue Integrity, Compliance Specialist, Internal Controls, Billing and Collections, Revenue Managers, and Health Care Administrators) to ensure coding feedback to outsourcing vendors and teams is provided with adherence to best practices and controlling guidelines
· Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges.
· Consult with and provide feedback to physicians or departments on coding practices and conventions to provide detailed coding information. Communicate with clinical, ancillary staff, and revenue managers for needed documentation to ensure accurate reporting.
· Develop and maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD-10 CM and CPT-4 coding guidelines to inpatient/outpatient diagnoses and procedures.
· Develop and maintain a thorough understanding of medical record practices, standards, regulations, HIPAA, Health Care/Finance Administration (HCFA), CMS, and other payer policies and any health care relevant channels.
· Develop and maintain a thorough understanding of payer-specific guidelines as it pertains to edit review and denial management.
· Ensure active participation in any team event and departmental activities in the PRMO and DUHS
· Ensure compliance with PRMO and DUHS policies and code of conduct
· Assist with special projects as required
Medical Records Coder II-Vendor Support-PB Coding Denials
This is a progressive coder/auditor position with opportunities for development and growth, accountable for key strategic vendor education, and ensures coding accuracy for vendor services. The ideal candidate has experience and knowledge in coding/billing, denials, and payer guidelines, as well as well-developed analytical skills in this area. The position is a forward-facing role that will have regular access to and communication with our coding vendor partners. Coding certification is required, and additional certification for auditing is preferred.
Quality Control (40%)
- Review of vendor work to identify erroneous coding p patterns and errors
- Providing feedback and education to vendor services to address issues found
- Monitoring and tracking of QC result
- Provide coding process analysis and support for the department as an expert for the outsourcing partner QC team and supervisors.
Vendor Education (30 %)
- Plan activities aimed at improving the Coding Vendor's quality performance in operations
- Design and implement strategies for enhancing vendor's work quality and increasing productivity.
- Evaluate the effectiveness of the improvement strategy through sustained tracking and monitoring of the vendor's related WQ.
- Reporting of vendor-specific trends and issues to upper management
Coding (30%)
- Performing actual coding functions, including but not limited to charge review edits, coding denials, rejections, and appeals
- Performing necessary research and investigation to resolve coding-related issues and enhance the business process associated with job functions and responsibilities
- Maintaining skills by continuing education and keeping abreast of regulatory healthcare-related changes and payer rule updates
Required Qualifications at this Level
Education:
High school graduate, Bachelor is preferred
Experience:
Minimum of 2 years of work experience in a coding-related function and/or Auditing experience; Epic experience is a plus
Degrees, Licensure, and/or Certification:
CPC, CP C-P, CCS, CCS-P, CPMA, RHIT, RHIA, COC, CPMA
Knowledge, skills, and abilities:
Efficient written and verbal communication skills
Ability to integrate Coding knowledge with Analytical Skills in solving complicated coding scenarios and denials
Ability to utilize available data to identify trends and workflow improvements
Ability to communicate with customers/staff with diverse educational backgrounds
Ability to provide feedback and education in a group setting or remotely
Attention to detail and accuracy
Ability to work independently and with a team
Ability to initiate and complete projects as directed by departmental leadership
Computer literacy
Time management to be able to perform rm job function remotely and efficiently
Distinguishing Characteristics of this Level
Be able to teach coding concepts effectively to a diverse audience.
This job description intends to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be used as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Minimum Qualifications
Duke is an affirmative action/equal opportunity employer committed to providing employment opportunities 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 essential job 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.
Education
High school diploma required.
Experience
RHIA certification-no experience required RHIT certification-no experience required CCS certification: one year of coding experience required; dCPC or HCS-D certification: two years of coding experience required
Degrees, Licenses, and Certifications
Must hold one of the owing active/current certifications: Registered Health Information Administrator (RHIA) Hospital CodingRegistered Health Information Technician ( RHIT) Hospital CodingCertified Coding Specialist (CCS) Hospital CodingCe Certified Professional Coder (CPC)Homecare Coding Specialist-Diagnosis (HC S-D) Homecare Coding
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.