Duke University Health System

Clinical Specialist

• Reviews clinical documentation and facilitates modifications to ensure that documentation accurately reflects the reason for admission, intensity of service rendered, risk of mortality, and conditions present on admission for all patients.
• Maintains a system to identify admissions for chart reviews.
• Initiates chart review within 24-48 hours of identification.
• Monitors the reviewed medical record every 48 hours to determine compliance to established documentation standards.
• Notifies the attending physician and house staff officers or other disciplines promptly of chart deficiencies requiring clarification.
• Conducts follow-up reviews to ensure points of clarification have been addressed in the medical record.
• Maintains ongoing record of the results of each chart review.
• Serves as resource to physicians and other healthcare team members for published DRG, SOI/ROM, ICD-9, ICD-10 and PCS information.
• Compiles and provides timely entry to CDI database for statistical reporting.
• Assists with review of the medical record post discharge to determine coding status.

Clinical Document Integrity Specialist

Revenue Operations

• Identify existing and future revenue cycle-based improvement opportunities
• Lead PRMO discussions, evaluations, selections and prioritization of improvement opportunities, including the development of an ROI analysis to better understand and determine potential impact on overall PRMO performance
• Work closely with PRMO leadership to understand operational goals and challenges to identify opportunities for enhancements
• Perform and prepare regular root cause analysis of performance of the revenue cycle function to identify areas of opportunity utilizing various data systems including Slicer Dicer and Tableau
• Responsible for various standard, recurring reporting functions to support revenue cycle operational business needs
• Monitor key performance indicators for internal and external parties
• Cultivates internal relationships to assist in understanding department workflows
• Support investigation into claims/denials patterns, payer policy changes, collection rate shifts, avoidable write-off’s, and payer mix evaluation to optimize payer performance.
• Point person for month-end Revenue Cycle Net Revenue Review
• Create, design, lead, and implement strategies that will reduce AR, improve aging AR, improve net collection rate, eliminate waste through automation or optimization of workflows, reduce denials, and reduce avoidable write -oﬀs, for all areas of the Revenue Cycle
• Develop, maintain, and enhance knowledge of Revenue Cycle systems and third-party vendors to support recommendations for optimal workflows.

Business Process Consultant – Revenue Assurance

Administration

• Provide strategic, operational, and financial leadership for multiple ambulatory clinic locations
• Ensure high-quality patient care, financial sustainability, and operational efficiency across all assigned locations
• Partner with physician and advanced practice provider leadership, Nurse Managers, and Clinic Managers
• Drive service line performance and align operations with DUHS goals, regulatory standards, and patient experience expectations

Practice Administrator

Physician

• Address personal health care needs of new and established patients primarily through virtual, video-based encounters
• Develop long-term, patient-centered relationships with the goal of achieving outstanding health outcomes and an exceptional patient experience
• Work collaboratively in a multidisciplinary, virtual, team-based environment
• Provide comprehensive primary care via video visits: diagnosis and treatment of acute illness, evaluation and management of chronic disease, and preventive and wellness care
• Receive support from a dedicated Virtual Care Center nursing and triage team, remote patient monitoring (RPM) tools, and population health resources

Virtual Primary Care Physician

• Coordinate revenue cycle activities
• Monitor performance for staff responsible for appointment scheduling
• Develop and prepare/utilize reports to track financial and operational performance
• Review and recommend changes to the department's charge master(s)
• Identify revenue cycle problems and implement solutions for improvement
• Act as a liaison to management and staff in the designated clinical area

Clinical Document Integrity Specialist

Business Process Consultant – Revenue Assurance

Practice Administrator

Virtual Primary Care Physician

Facility Revenue Manager – Ambulatory Surgery Centers