Reimbursement Specialist - Emergency Services

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.

About Duke University Hospital

Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States and is the number one hospital in North Carolina, according to U.S. News and World Report for 2023-2024. Duke University Hospital is the largest of Duke Health's three hospitals and features 1048 patient beds, 65 operating rooms, as well as comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.

General Description of the Job Class:

Compile, analyze, and report on the performance of departmental operating units, noting trends and making recommendations or conclusions regarding progress.

Duties and Responsibilities of this Level

Audits all DUH Emergency Department patient encounters:

• Audit charts in EPIC work queue 11885 ensuring that nursing documentation justifies the charges automated by the charge calculator and adding any charges that were missed by the charge calculator

• Ensure charges automated by the EPIC billing system are in accordance with current ACEP guidelines, making changes to the ED leveled charge when needed

• Enter trauma level codes to billable patient charts based on information received daily from the Trauma Registrars

• Add 450 Revenue Code to ED patient encounters missing a revenue code

• Respond to inquiries from the compliance department regarding ED patient charges

• Maintain spreadsheet of corrections (additions or deletions) made to ED patient encounters for monthly and annualized leadership review

• Serve as a point of contact for unique no-bill situations including secret service agent COVID testing, Life Flight Organ trips, etc., ensuring a bill is not generated in these cases

Audits Life Flight Billing:

• Audit billing performed by the third-party vendor, Golden Hour

• Using the daily Flight Vector log, ensure Golden Hour billed using correct dates, mileage, zip codes; ensure emsChart is attached in EPIC

• If Golden Hour has not billed within 10 days of Life Flight trip, upload the trip information to the error spreadsheet

• Communicate errors to Golden Hour monthly, informing them the % of errors for the month and the dollar amount associated with the errors

• Analyze and provide feedback for departmental specific reports.

• Utilizes clinical and coding knowledge to ensure accurate and compliant charge items and to recognize and resolve billing inconsistencies.

• Coordinates projects and audits to improve processes related to revenue cycle, efficiency of charging and billing, and collection efforts.

• Assist management in forecasting by providing historical information. Work with departmental directors, managers and appropriate personnel to ensure budgetary compliance.

• Manage appropriate systems for accounts receivable and/or financial reporting and prepare written reports and analyses for PRMO, DUHS and PDC leadership documenting trends and appropriate recommendations/conclusions.

• Coordinate communication between insurance companies, governmental agencies, providers and support staff.

• Trend and report on departmental performance indicators and goals. Ensure departmental goals are satisfied.

• Make recommendations to improve financial systems; perform in house audits of operating units; analyze deficiencies and report to manager/director.

• Assist in developing and defining short and long term departmental specific goals and objectives.

• May be responsible for managing and delegating database inquiries. Creation and development of work assignments including training of employees.

• Maintain professional relationship with internal and external agencies and professional organizations concerning operations.

• May serve as liaison between the physicians and the PRMO.

• May conduct employee quality reviews in support of OER (Overall Effectiveness Rating) performance evaluations, and provide feedback to management and relevant employees.

• Develop and provide job-specific training to new and existing employees within the department.

• Perform other related duties incidental to the work described herein

Minimum Qualifications 

Education 

A high school diploma or equivalent is required, preferably supplemented by post-secondary courses in Accounting, Finance, Economics, Business Administration or a related field.

Experience

Four years of related experience in healthcare is required. A Bachelor's degree in a related field can substitute for the experience requirement. Flight Vector experience strongly preferred. 

Knowledge, Skills, and Abilities

Data analysis and reporting, Billing/Collection, Insurance Claim, Microsoft Office (Excel, Access, Word, PowerPoint). Good communication skills (verbal and written) are essential.

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 onthe 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.