Revenue Integrity Analyst, CDM, 100% Remote, M-F

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.

Patient Revenue Management Organization

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

General Description of the Job Class

This position serves a critical function within Duke Health's Charge Description Master (CDM) team by supporting revenue integrity and charge capture optimization initiatives. Responsibilities include reviewing pre-bill accounts flagged through Epic Revenue Guardian edits and entering missing hospital (HB) charges based on supporting medical documentation. This role leverages critical-thinking and analytical skills to evaluate charge capture opportunities, determine appropriate charge corrections, and develop strategies for implementing new Revenue Guardian edits to reduce revenue leakage. The position exercises independent judgment and problem-solving abilities while providing analytical support related to third-party payer reimbursement and contract compliance.

Duties and Responsibilities of this Level

• Responsible for conducting quality control audits to ensure data/documentation integrity, and trending of accounts that qualify for Revenue Guardian edits. This includes compilation by clinical department for education deliverables. (20%)
• Serves as Subject Matter Expert to leadership on issues related to Revenue Integrity. (10%)
• Preparation of monthly reports and educational presentations for clinical departments and Revenue Manager teams. Compilation of data trends will be monitored to validate documentation improvement initiatives and optimizing charge capture activities. (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 line education strategies to promote complete and accurate clinical documentation; using root cause analysis to correct negative trends, behaviors and able to impart this knowledge to provider and other health team members. (20%)
• Review charges and payments for accuracy from contracted payers and management of appeals process with each assigned payer, in both the hospital and clinic setting. Identify revenue gains (gross dollars/percentage for net) through various reporting tools. (20%)
• Perform other related duties incidental to the work described herein. (10%)

Required Qualifications at this Level

• Education: Bachelor's degree in business administration, accounting, management, healthcare administration, nursing or other related degree.
• Experience: 3 years of experience related to coding is required. Charge capture, reporting, and analysis experience is preferred.
• Degrees, Licensure, and/or Certification: Coding certification (e.g. CPC, CCS, RHIA, RHIT) is required.
• Knowledge, Skills, and Abilities: In-depth knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements. Revenue Cycle experience. Strong oral and written communication skills. Research-oriented with ability to critically analyze and reason large amounts of data.

Distinguishing Characteristics of this Level

N/A

The intent of this job description is 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 construed 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.

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.

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.