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REIMBURSEMENT ANALYST I
Job Title: REIMBURSEMENT ANALYST I
Job Code: 1883
Job Level: 10
Job Family: JF 28
Participate in a variety of activities to enhance billing and collection efforts related to third party reimbursements of professional charges.
Monitor professional billing system by cost center; maintain systems to capture all inpatient and outpatient charges, including consults.
Assist with establishing physician fee schedule, by CPT codes, for each cost center and for the department; assist with reimbursement analysis, and regulatory compliance monitoring.
Identify and define appropriate CPT codes for existing and new services.
Prepare management reports on billings, collection and patient mix as required.
Assist with budgets for each cost center based on trend analysis and projected market data.
Assist with on-going in-service training for staff on proper coding guidelines, insurance regulations, medical records and physician documentation and signature requirements.
Serve as liaison between the physicians and the PDC's concerning billing issues and fee setting.
Consult with and advise physicians regarding billing problems and initiate plans for solving such problems.
Follow-up third party denials with the Billing and Collection Department
Review patient care account receivables and work with the physicians and Collections Department to reduce outstanding debts and troubled accounts. Perform other related duties incidental to the work described herein.
The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.
Required Qualifications at this Level
Work requires knowledge of accounting or business principles and practices generally obtained through completion of a bachelor's degree program in an accounting or business related field.
Work requires three years related business or administrative experience to acquire competence in applying general accounting principles, knowledge of insurance billing and collection procedures, including CPT and ICD-9 coding.
OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE
The intent of this job description is to provide a representative and 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 University is an Affirmative Action/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, sexual orientation, or veteran 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.