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.

General Description:

The Charge Description Master (CDM) holds primary responsibility for managing all aspects of CDM maintenance for Duke University Health System (DUHS) including audit, analysis and verification of charging procedures and ensuring accuracy of coding in the CDM; working collaboratively with key stakeholders, including DUHS clinical operations staff, finance/revenue management, and revenue/operational managers within the Patient Revenue Management Organization (PRMO); monitoring compliance with Federal and State guidelines; prioritizing and maintaining timely turnaround; serving as resource when necessary for billing / reimbursement issues; performing periodic audits; providing customer service, including education of CDM processes; and coordination of activities of CDM Analysts.

Key Responsibilities:

• Responsible for the development, implementation, and maintenance of the CDM, ensuring accurate CPT/HCPCS and revenue coding.

• Works with the revenue producing departments to ensure the ongoing coordinated and consistency with the CDM and Charge Capture processes, including accurate descriptions, coding, additions, deletions, pricing, revenue code and any other changes.
• Continuously reviews and updates regulations and maintains current knowledge base
• Interprets government regulations and affects related process changes throughout the system to ensure compliance with these regulations as they relate to the CDM.
• Performs the daily audit maintenance functions to ensure compliance, accuracy, and consistency of the CDM.
• Works with internal controls and compliance to design audit processes, policies and procedures.

• 25%

  Assists in data analysis, periodic audits, and information queries, external audits and special projects. Review results of periodic audits and take appropriate action as indicated
• Coordinates the annual CDM update process.
• Serves as internal resource and expert on CDM issues and reporting
• Assists as needed, with data entry, billing/audit questions, facility inquires, education, database maintenance, statistical analysis and processing of reviews of internal audits

• 20%

  Provides leadership and direction for departments on CDM strategies in accordance with state and federal regulatory guidelines, CMS and Medicare Administrative Contractor rules and regulations, Medicaid specific rules and regulations, and Managed Care contract terms.
• Make recommendations for CDM process improvement.
• Provide system training and/or identify other training resources to support CDM activities.
• Maintain a working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist the health system in cash collection while accurately complying with billing guidelines.
• Work with DUHS Revenue Management, DUHS Finance, to perform applicable analyses to understand budget, gross and net revenue change of proposed CDM changes.
• Advises and collaborates with the Compliance Officer, Internal Audit, Regulatory Review and Analysis, legal counsel and outside consultants to analyze, review and assess identified billing, coding, charging and compliance issues.

• 20%

  Meet regularly with CDM Analysts to help set priorities, assist with negotiating/eliminating various barriers to success.
• Perform/assist with HR functions for CDM team including; managing time and attendance; monitoring safety training requirements, participate in performance appraisal process.
• Perform other related duties incidental to the work described herein.

Required Qualifications at this Level

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Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob 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.