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Clinical Trials Revenue Analyst
2 months ago
Overview
At Duke Health, our mission is to provide compassionate care that positively impacts patients, their families, and the broader community. We are committed to advancing health through collaboration and innovation.
About the Patient Revenue Management Organization
The Patient Revenue Management Organization (PRMO) at Duke Health is a comprehensive, centralized revenue cycle management entity that enhances the efficiency of the revenue cycle across the health system. This encompasses essential functions such as scheduling, registration, coding, and billing.
This role may offer remote work opportunities, with the requirement that all remote employees reside in designated states or districts.
Position Summary
Reporting to the Manager of Clinical Trials Billing within the PRMO, the Revenue Integrity Analyst plays a crucial role in ensuring the success of the research billing program at Duke University Health System (DUHS). The analyst will collaborate with clinical departments, billing teams, and utilize reporting tools to oversee incoming payments and claims related to clinical trials and innovative therapies.
Key Responsibilities
- Evaluate payment accuracy from contracted payers and facilitate the appeals process for clinical trial claims and services that are newly introduced to the market. Provide analytical insights to the PRMO insurance follow-up teams. (20%)
- Gather data, generate reports, and present analyses regarding clinical trial billing and new services to management and other stakeholders on a regular basis. (20%)
- Coordinate with health team members to ensure comprehensive and accurate documentation in medical records. Collaborate with operational leaders to develop educational strategies for providers aimed at enhancing clinical documentation and addressing negative trends. (20%)
- Conduct quality control audits to maintain data integrity, communicate findings, and oversee corrective actions within operational units. (20%)
- Act as a subject matter expert for leadership on matters related to new services. (10%)
- Perform additional related duties as necessary. (10%)
Education
Bachelor's degree in business administration, accounting, finance, healthcare administration, nursing, or a related field.
Experience
A minimum of 3 years of experience in auditing and/or claims billing is required. Coding experience is advantageous.
Certifications
Coding certification (e.g., CCS, RHIA, RHIT), project management certification (PMP), or Six Sigma training is preferred. Epic certification is a plus.
Knowledge, Skills, and Abilities
- Comprehensive understanding of Medicare/Medicaid and commercial insurance regulations, including billing, coding, and documentation requirements.
- Ability to create monthly reports on metrics and claims volume, effectively communicating findings to leadership.
- Strong oral and written communication skills, with the capacity to make informed recommendations through effective interpersonal interactions.
- Proficient in generating ad hoc reports to analyze complex data and present findings to influence decision-making.
- Adept at recognizing the implications of Epic system settings on research billing workflows.
- Resourceful and collaborative, with prompt follow-up on critical billing issues.
- Proficient in Microsoft Office suite and communication tools such as Zoom and MS Teams.
- Familiarity with healthcare applications and systems, including EPIC, OnCore, and SAP accounting tools.
- Strong understanding of clinical research processes and insurance claim requirements is preferred.
Duke is an Affirmative Action/Equal Opportunity Employer dedicated to providing employment opportunities without regard to age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status. We strive to foster a community built on collaboration, innovation, and belonging, where diverse perspectives and experiences are valued.
