Reimbursement Specialist - Patient Financial Services - 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.

 

 

REMOTE POSITION: Monday - Friday

*** Must reside in North Carolina ***

 

 

General Description of the Job Class:

•    Perform quality assurance reviews of accounts which impact revenue cycle activities as well as adherence to compliance and regulatory requirements
•    Compile, analyze and report on QA performance of departmental operating units, noting trends and making recommendations or conclusions which are in alignment with the financial performance of the Health System.
•    Review financial reporting and trends impacting reimbursements/cash projections (denials/write offs/performance dashboards); coordinate projects and quality assurance reviews based on trends; provide workflow recommendations for discovered deficiencies to improve reimbursement/cash projections 
•    Track financial performance related to changes in workflow and/or recommendations
•    Provide front end registration support to outpatient clinics as needed. 

 

Duties and Responsibilities:
Quality Assurance and Ambulatory Support: (95%) 
•    Perform quality assurance reviews of arrived patient encounters based on assigned clinics and/or area(s) of focus. 
•    Maintain documentation of quality assurance scores and trends, in accordance with compliance guidelines as it relates to the file maintenance, retention and PHI requirements.
•    Compile, analyze and report findings of departmental units; noting conclusions, trends and recommendations based on any identified deficiencies and/or opportunities for improvement to help support revenue cycle activities and reimbursements
•    Analyze data and provide feedback to individual departments for departmental specific reports and/or staff re-education opportunities
•    Review financial reporting and trends impacting the overall financial performance of the Health System (i.e. denials/write offs/performance dashboards)
•    Coordinate projects and quality assurance reviews based on financial reporting and trends negatively impacting reimbursements/cash (denials/write offs/compliance and/or regulatory requirements); provide recommendations to local and/or departmental leadership based off identified deficiencies and/or opportunities for improvement
•    Track financial performance related to operational workflow changes to ensure positive financial results based on these changes
•    Review and analyze accounts to ensure adherence with compliance and regulatory requirements (i.e. MSPQ,  HITECH, COA/COT, ABN) which have potential negative financial implications to the Health System
•    Meet assigned deadlines
•    Participate in Service Access training opportunities to ensure up to date knowledge of system and workflow changes
•    Perform quality assurance reviews independently with minimal supervision
•    Utilize front end registration knowledge to ensure accurate analysis of accounts reviewed
•    Assist in developing and defining short and long term departmental specific goals and objectives.
•    Provide front end registration support to outpatient clinics as needed.
•    Maintain outpatient registration competencies in the Patient Service Associate / Financial Care Counselor job description as part of their quality assurance review responsibilities. 
•    Develop training material (Standard of Work, job aides, tip sheets, etc) in support of Ambulatory Service Access initiatives.
•    Demonstrate expected behaviors which contribute to a positive patient experience. 

 

General: (5%) 

•    Attends meetings and participates on committees, as assigned. 
•    Develop and provide job-specific training to new and existing employees within the department. 
•    Perform all other related duties incidental to the work described herein. 
•    Accomplishes all tasks as appropriate. 
•    Living Duke’s Values by demonstrating expected behaviors, contributing to a positive work environment

 

Minimum Qualifications

Education
High school diploma or equivalent is required, preferably supplemented by post-secondary courses in Accounting, Finance, Economics, Business Administrat