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.
Duties and Responsibilities of this Level
Perform other related duties incidental to the work described herein.
Review medical record documentation and accurately assign codes for the primary/secondary diagnoses and procedures using ICD-10-CM, ICD-10-PCS, CPT-4 and HC PCS Level II.
Sequence diagnoses and procedures using coding guidelines.
80% of time spent
Maintain competency in ICD-10-CM, ICD-10-PCS, CPT-4 and HCPCS Level II and knowledge of reimbursement reporting requirements.
Maintain a thorough understanding of anatomy and physiology, medical terminology, pharmacology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM coding guidelines for assignment of outpatient diagnoses and CPT-4 and HCPCS Level II for procedures.
Knowledge of coding and charging requirements to ensure accurate code submission along with management of edits and denials.
Knowledge of UHDDS definitions and data requirements to support accurate coding and data collection.
Knowledge of NCD/LCD edits to support compliance with medical necessity.
Apply knowledge of all coding reference materials and education to problem solve unique or new cases resulting in the assignment of appropriate diagnosis and procedure codes.
5% of time spent
Use logic and reasoning to demonstrate critical thinking in the assignment of diagnosis and procedure codes with consideration for reimbursement, quality and other data capture requirements.
10% of time spent
Query physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
5% of time spent
Maintain compliance with quality and quantity standards as outlined in DUHS HIM Coding Policies.
Abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
High school diploma required.
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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