REVENUE INTEGRITY ANALYST-Clinical Trials, 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.

 

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

 

Reporting to the Manager of Clinical Trials Billing in the PRMO, the Revenue Integrity Analyst in Clinical Trials plays a vital role in the success of DUHS’ research billing program. Through collaboration with clinical areas, billing teams, and reporting tools, the incumbent will monitor incoming payments and claims related to both clinical trials and new-to-market therapies.

 

The revenue Integrity Analyst must reconcile payments received against existing contracts and authorization terms. This will require independent decision-making using analytical and problem-solving skills. This role provides critical analytical and negotiation support concerning third-party payer reimbursement contracts.

 

Duties and Responsibilities of this Level

 

 

• Review payments for accuracy from contracted payers and inform the appeals process for clinical trial claims and services that are new to the market. Provide analytical feedback to PRMO insurance follow-up teams. (20%)
• Compile information, prepare reports, and present analyses for clinical trial billing and new-to-market services to the manager and other DUHS stakeholders on a routine basis. (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 education strategies to promote complete and accurate clinical documentation and correct negative trends and can impart this knowledge to providers and other health team members. (20%)
• Responsible for conducting quality control audits to ensure data/documentation integrity, communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within the operational units. (20% )
• Serve as subject matter expert to leadership on issues related to new-to-market services. (10%)
• Perform other related duties