PRMO: , established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke PrimaryCare. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke's reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.
The Medical Records Coder II - Hospital Billing, Vendor Services will coordinate/review the work of vendor outsourcing partners and assist with the training and continuing education programs. Code medical records utilizing ICD-10CM and CPT-4 coding conventions. Review the medical record to assure specificity of diagnoses, procedures and appropriate/ optimal reimbursement professional charges. Abstract information from medical records following established methods and procedures.
Duties and Responsibilities
Ensure quality and quantity of work performed through regular audits and QC for vendor services specifically in the area of HB coding related Denials and Rejections.
Monitor and track outsourcing vendor performance as it pertains to QC and Productivity
Review and research 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 tools for any relevant topic as it relates to continuing education programs on areas of specialization, coding, operational workflow and quality control.
Collaborates with other departments and partners (e.g. Revenue Integrity, QA Team,Compliance Specialist, Internal Controls, Billing and Collections and Revenue Managers) to ensure coding feedback to outsourcing vendors and team are provided.
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 department on coding practices and conventions in order to provide detailed coding information. Communicate with clinical, ancillary staff and revenue managers for needed documentation to ensure accurate coding.
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 thorough understanding of medical record practices, standards, regulations, Health Care/Finance Administration (HCFA) and Uniform Billing (UB-04), CMS, and other payer policies and any health care relevant changes.
Develop and maintain a thorough understanding of payer specific guidelines as it pertains to edit review and denial management.
High school diploma required.
*STRONGLY PREFERRED: CPC with 2 years of coding experience, or CCS; Auditing experience in the medical records coding space; Multi-speciality coding.
RHIA certification- no experience required
RHIT certification- no experience required
CCS certification- one year of coding experience required
CPC or HCS-D certification- two years of coding experience required
Degrees, Licensures, Certifications
Must hold one of the following active/current certifications: Registered Health Information Administrator (RHIA) Hospital Coding Registered Health Information Technician (RHIT) Hospital Coding Certified Coding Specialist (CCS) Hospital Coding Certified Professional Coder (CPC) Homecare Coding Specialist-Diagnosis (HCS-D) Homecare Coding
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