Clinical Trials Revenue Integrity Specialist
2 weeks ago
About Duke Health
At Duke Health, our mission is to provide compassionate care that transforms the lives of patients and their families, as well as the broader community. We are dedicated to advancing health through collaboration and innovation.
Overview of the Patient Revenue Management Organization
The Patient Revenue Management Organization (PRMO) is a fully integrated revenue cycle management entity that enhances the efficiency of the revenue cycle across Duke Health. This encompasses essential functions such as scheduling, registration, coding, and billing.
Position Summary
The Revenue Integrity Analyst for Clinical Trials plays a crucial role in the research billing program at Duke University Health System (DUHS). Reporting to the Manager of Clinical Trials Billing, this position involves collaboration with clinical departments, billing teams, and analytical tools to oversee incoming payments and claims associated with clinical trials and innovative therapies.
Key Responsibilities
- Evaluate payment accuracy from contracted payers and guide the appeals process for clinical trial claims and new market services. Provide analytical insights to the PRMO insurance follow-up teams. (20%)
- Gather data, generate reports, and present analyses related to clinical trial billing and new market services to management and other stakeholders regularly. (20%)
- Coordinate with health team members to ensure thorough and accurate documentation in medical records. Collaborate with operational leaders to develop educational strategies for providers to enhance clinical documentation and address negative trends. (20%)
- Conduct quality control audits to verify data integrity and documentation, communicate findings, and oversee corrective actions within operational units. (20%)
- Act as a subject matter expert for leadership on matters concerning new market services. (10%)
- Perform additional related duties as required. (10%)
Education
A Bachelor’s degree in business administration, accounting, finance, healthcare administration, nursing, or a related field is required.
Experience
A minimum of 3 years of experience in auditing and/or claims billing is necessary. 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 standards.
- Ability to create monthly reports on metrics and claims volume, and effectively communicate findings to leadership.
- Strong oral and written communication skills, with the capability to provide sound recommendations through effective interpersonal interactions.
- Proficient in generating ad hoc reports to analyze complex data and report findings to drive solutions.
- Adept at recognizing the impact of Epic system settings on research billing workflows.
- Resourceful and collaborative, with prompt follow-up on critical patient billing issues.
- Proficient in Microsoft Office suite and telecommunication tools.
- Familiarity with healthcare applications such as EPIC, OnCore, and SAP accounting tools is highly desirable.
- Strong understanding of clinical research processes and insurance claim form 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.
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