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Duke Health

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values. Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

Revenue Integrity Analyst, Remote, M-F

ComplianceComplianceOtherRemoteTeam 10,001

Location

United States

Posted

107 days ago

Salary

0

No structured requirement data.

Job Description

Revenue Integrity Analyst, Remote, M-F

Duke Health

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. Patient Revenue Management Organization Pursue your passion for caring with the Patient Revenue Management Organization, which is the 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 for Duke Health. General Description of the Job Class Perform medical and revenue audits to ensure revenue integrity as related to adherence to federal and state regulations: policies of external payers, coding rules and guidelines. Exercise independent decisions using analytical and problem-solving skills. Provides critical analytical and negotiation support with respect to third-party payer reimbursement contracts. Duties and Responsibilities of this Level Responsible for responding to all HB and PB government and commercial audits/additional documentation requests in a timely manner. Responsible for all follow up of any denials to include Discussion requests, 1st level appeals, 2nd level appeals, Administrative Law Judge and Medicare Administrative Contractor appeals as necessary (30%) Responsible for conducting quality control and prospective audits to ensure data/documentation integrity; compiling information and/or preparing reports and analyses communicating results with appropriate recommendations, including regulatory requirements, and overseeing the corrective actions for audits within the operational units. (10%) Serve as Subject Matter Expert in leadership on issues related to revenue integrity (external medical audit request). (10%) Perform pre-bill analysis of Medicare accounts with high likelihood of future audit and/or clinical issues with adherence to guidelines prior to release. Work with clinics and stakeholders to ensure accurate data and guidelines met. (20%) Follow up with appropriate health team members to ensure accurate and complete documentation in the medical record. Work collaboratively with the appropriate operational leaders to develop provider and service line education strategies to promote complete and accurate clinical documentation, using root cause analysis to correct negative trends and behaviors, and be able to impart this knowledge to providers and other health team members. (10%) Review charges and payments for accuracy from contracted payers and management of the appeals process with each assigned payer in both the hospital and clinic settings. Provides critical analysis and negotiation on behalf of DUHS with respect to third-party payer reimbursement contracts. (10%) Perform other related duties incidental to the work described herein. (10%) Required Qualifications at this Level Education: Bachelor's degree in business administration, accounting, management, healthcare administration, nursing or another related degree. Experience: 3 years of experience related to auditing and/or coding is required. Clinical experience is preferred Degrees, Licensure, and/or Certification: Coding certification (e.g. CPC, CCS, RHIA, RHIT) or applicable experience is preferred. Nursing strongly preferred. Knowledge, Skills, and Abilities: In-depth knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements. Knowledge of reimbursement methodologies – DRG, Case Rate, Groupers, APC. Revenue Cycle and/or denial management experience Strong oral and written communication skills. Intermediate knowledge and skill with Microsoft Office products—Excel, PowerPoint, Outlook, and OneNote. Research-oriented with ability to critically analyze and reason large amounts of data Distinguishing Characteristics of this Level N/A The intent of this job description is to provide a representative level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description. Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values. Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

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Marqeta logo

Compliance Manager

Marqeta

You see a card. We see endless possibilities.™

Compliance107 days ago
Full TimeRemoteTeam 501-1,000Since 2010H1B Sponsor

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Job Closed

Associate Director, Regulatory Affairs - Advertising and Promotion

Insmed

Insmed is a global biopharmaceutical company dedicated to creating life-transforming therapies for patients with serious and rare diseases that have limited tre

Compliance107 days ago

At Insmed, every moment and every patient counts — and so does every person who joins in. As a global biopharmaceutical company dedicated to transforming the lives of patients with serious and rare diseases, you’ll be part of a community that prioritizes the human experience, celebrates curiosity, and values every person’s contributions to meaningful progress. That commitment has earned us recognition as Science magazine’s No. 1 Top Employer for five consecutive years, certification as a Great Place to Work® in the U.S., and a place on The Sunday Times Best Places to Work list in the UK. For patients, for each other, and for the future of science, we’re in. Are you? About the Role: We’re looking for an Associate Director, Regulatory Affairs – Advertising and Promotion to help us expand what’s possible for patients with serious diseases. 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Job Closed

Senior Director, Regulatory Affairs – Gene Therapy

Insmed

Insmed is a global biopharmaceutical company dedicated to creating life-transforming therapies for patients with serious and rare diseases that have limited tre

Compliance107 days ago

At Insmed, every moment and every patient counts — and so does every person who joins in. As a global biopharmaceutical company dedicated to transforming the lives of patients with serious and rare diseases, you’ll be part of a community that prioritizes the human experience, celebrates curiosity, and values every person’s contributions to meaningful progress. That commitment has earned us recognition as Science magazine’s No. 1 Top Employer for five consecutive years, certification as a Great Place to Work® in the U.S., and a place on The Sunday Times Best Places to Work list in the UK. For patients, for each other, and for the future of science, we’re in. Are you? About the Role: We’re looking for a Senior Director on the Regulatory Affairs, Gene Therapy team to help us expand what’s possible for patients with serious diseases. Reporting to the VP, Regulatory Affairs, Gene Therapy you’ll serve as the regulatory lead at the Global Project Team (GPT) for assigned program(s). 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It can be performed effectively from anywhere while staying connected to your Insmed team and community. Occasional travel for team meetings or events will be expected. Travel Requirements This role requires occasional travel (approximately 25%) #LI-REMOTE #LI-MC1 Pay Range: $222,000.00-303,000.00 Annual Life at Insmed At Insmed, you’ll find a culture as human as our mission—intentionally designed for the people behind it. You deserve a workplace that reflects the same care you bring to your work each day, with support for how you work, how you grow, and how you show up for patients, your team, and yourself. Highlights of our U.S. offerings include: - Comprehensive medical, dental, and vision coverage and mental health support, annual wellbeing reimbursement, and access to our Employee Assistance Program (EAP) - Generous paid time off policies, fertility and family-forming benefits, caregiver support, and flexible work schedules with purposeful in-person collaboration - 401(k) plan with a competitive company match, annual equity awards, and participation in our Employee Stock Purchase Plan (ESPP), and company-paid life and disability insurance - Company Learning Institute providing access to LinkedIn Learning, skill building workshops, leadership programs, mentorship connections, and networking opportunities - Employee resource groups, service and recognition programs, and meaningful opportunities to connect, volunteer, and give back Eligibility for specific programs may vary and is subject to the terms and conditions of each plan.  Current Insmed Employees: Please apply via the Jobs Hub in Workday. Insmed Incorporated is an Equal Opportunity employer. We do not discriminate in hiring on the basis of physical or mental disability, protected veteran status, or any other characteristic protected by federal, state, or local law. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Unsolicited resumes from agencies should not be forwarded to Insmed. Insmed will not be responsible for any fees arising from the use of resumes through this source. Insmed will only pay a fee to agencies if a formal agreement between Insmed and the agency has been established. The Human Resources department is responsible for all recruitment activities; please contact us directly to be considered for a formal agreement. Insmed is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation to participate in the job application or interview process, please contact us by email at TotalRewards@insmed.com and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address. Applications are accepted for 5 calendar days from the date posted or until the position is filled.

United States
$222K - $303K / year
Job Closed