HIM SPECIALIST

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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.

Occ Summary

Independently performs specialized or advanced health information activities necessary to organize, maintain, and use electronic patient health records. Activities required include research, analysis and compilation of findings into summarized reports that will be shared within and external to the Health Information Management Department. Positions at this level have high customer service and strong analytic and problem-solving skills and require interpretation and explanation of policy and external requirements related to privacy, release of information, positive patient identity, and other department and organization-wide functions. Specific job responsibilities are based on the service unit within Health Information Management assigned.


Expert computer skills to navigate and query multiple electronic record systems. Release of Information: Regular interaction is required with patients, attorneys, governmental agencies, providers of health care, insurance companies, auditing agencies, and researchers. Detailed working knowledge and ability to apply HIPAA rules, North Carolina General Statutes, and other state and federal laws regarding patient privacy. Patient Identity Management: Regular interactions are required with patients, attorneys, insurance companies, providers of healthcare and governmental agencies. Detailed working knowledge and ability to apply state and federal laws regarding positive patient identification, identity theft, vital records regulations, JointCommission requirements, and CMS guidelines and rules.

Work Performed

Release of Information Functions: Review the request for medical records to identify dates of service, entity, provider and specific clinical documents requested. Works extensively in the electronic health record and decentralized electronic databases to locate specific clinical documents for the purpose of fulfilling a request. Reviews patient authorizations to validate HIPAA-required elements and validate legal authority of the requestor. Reviews NC and out-of-state subpoenas and court orders to determine if they are valid and returns them to the requestor if deemed invalid. Coordinates visits from health plan reviewers and research monitors through provision of electronic medical records, assignment of passwords and deactivation of passwords at the conclusion of visits.


Assists reviewer in locating specific documents as needed. Reviews requests for patient amendments, locates disputed documents in the electronic health record and notifies the provider of patient request for amendment. Tracks amendment request to ensure patient is notified of outcome within HIPAA-required timeframe. Obtains itemized statements from PRMO Self-Pay and uses them to calculate lien balances and generate an attorney lien letter and forwards the itemized statement to the requestor as needed. Obtains provider approval to release psychiatric encounter records when requested by a patient and seeks provider approval to release records for minor patients ages 12-17 to parents to comply with additional privacy protections under NC Statute and federal law. Accompanies certified copies or original health records to court and the location of scheduled depositions when required. Testifies in court and depositions as to the authenticity of health records containing PHI. Patient Identity Management Functions: Track, monitor and validate patient overlays that occur during patient registration and scheduling activities. Analyze and trend data for feedback to the appropriate department. Notifies compliance and affected departments of incorrect documentation location.


Coordinates Chart Correction Cases within Maestro Care include evaluation of help desk requests, assignment of correction tasks and verification of completion and closure of the case and verifies completion and closure of the case. Maintains an accurate Enterprise Master Patient Index (EMPI) through active research and comparison of potential duplicates and clinical history to resolve patient identification discrepancies, including necessary investigation of potential identity theft. Performs name and demographic changes with supporting documentation. Performs concurrent and retrospective contact moves. Analyzes the content of the health record document and coordinates with responsible providers, clinicians, and ancillary departments participating in the patient's care for record correction requirements to resolution. Leads clinical, ancillary and financial staff to assist in resolving overlay issues of multiple patient information in one medical record to resolve overlay within 24 hours of discovery of overlay. Participates in 24-hour on-call rotation. Maintains enterprise master patient index integrity, medical record number merges, un-merges and medical record number assignments electronically.


Performs name and demographic changes with supporting documentation. Works with management to compile and review trending reports for patient identity functions. Assists with preparation of procedure documentation to support processes and training. Performs other duties as assigned, including customer service focus in training providers and internal and external customers on chart correction / support ticket resolution.

Knowledge, Skills and Abilities

Good organizational skills, excellent investigative/analytic skills with detail orientation, and strong follow-through capabilities. Excellent verbal and written communication skills in order to effectively problem solve, develop working relationships and assist system users. Must be able to meet deadlines, work independently, set priorities and maintain confidentiality. Ability to work calmly and efficiently in high-pressure situations. Intermediate knowledge of human anatomy and physiology and medical terminology highly preferred. Intermediate to expert skills using Windows-based software, familiarity with information technology hardware and software in a local and wide area network environment.

Level Characteristics

N/A

Minimum Qualifications

Education

High school diploma required; associate's degree in health information management or related field preferred

Experience

Four years of experience in a healthcare-related field required, two of which must be in Health Information Management Or Candidates with an Associate's degree in HIM require two years of healthcare experience and one year of HIM-specific experience or Candidates with a Bachelor's degree in HIM require two years of healthcare Care experience or Candidates with a Bachelor's degree in healthcare require two years of HIM-specific experience

Degrees, Licensures, Certifications

preferred: RHIT/RHIA/CHPS/CHDA

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.