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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 Primary Care. 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.

Occ Summary

Independently performs specialized or advanced health information activities necessary to organize, maintain, and use electronic patient health records. Activities required include research, analysis, and compilation of findings into summarized reports that will be shared within and external to the Health Information Management Department.

 

Positions at this level have high customer service, strong analytic and problem-solving skills, and require interpretation and explanation of policy and external requirements related to privacy, release of information, positive patient identity, and other departmental and organization-wide functions. Specific job responsibilities are based on the service unit within Health Information Management assigned. Expert computer skills to navigate and query multiple electronic record systems.

 

Release of Information: Regular interaction is required with patients,attorneys, governmental agencies, providers of health care, insurance companies, auditing agencies, and researchers. Detailed working knowledge and ability to apply HIPAA rules, North Carolina General Statutes, and other State and Federal laws regarding patient privacy Patient Identity Management: regular interactions are required with patients, attorneys, insurance companies, providers of healthcare, and governmental agencies. Detailed working knowledge and ability to apply state and federal laws regarding positive patient identification, identity theft, vital records regulations, Joint Commission requirements, and CMS guidelines and rules.

 

Work Performed

 

Release of Information Functions:Review request for medical records to identify dates of service, entity, provider, and specific clinical documents requested. Works extensively in the electronic health record and decentralized electronic data bases to locate specific clinical documents for the purpose of fulfilling requests. Reviews patient authorizations to validate HIPAA required elements and validate the legal authority of the requestor. Examines NC and out-of-state state subpoenas and court orders to see if they are valid and, if so, returns them to the requestor. Coordinates visits from health plan reviewers and research monitors through the provision of electronic medical records, the assignment of passwords, and the deactivation of passwords at the conclusion of the visit.

 

Assists the reviewer in locating specific documents as needed. Reviews requests for patient amendments, locates disputed documents in the electronic health record, and notifies the provider of the patient request for amendment. Tracks amendment request to ensure patient is notified of outcome within HIPAA required timeframe. Obtains itemized statements from PRMO Self Pay and uses them to calculate lien balances, generate attorney lien letters, and forwards Itemized Statement to requestor as needed.

 

 

Obtains provider approval to release psychiatric encounter records when requested by the patient and seeks provider approval to release records for minor patients ages 12-17 to parents to comply with additional privacy protections under NC Statute and Federal Law. Accompanies certified copies or original health records to court and the location of scheduled depositions when required. Testifies in court and depositions as to the authenticity of health records containing PHI. Patient identity management Functions: Track, monitor, and validate patient overlays that occur during patient registration and scheduling activities. Analyze and trend data for feedback to the appropriate department. Notifies compliance and affected departments of incorrect documentation location. Coordinates chart correction cases within Maestro Care, including evaluation of help desk requests, assignment of correction tasks, verification of completion and closure of the case, and verifies completion and closure of the case. Maintains an accurate Enterprise Master Patient Index (EMPI) through active research and comparison of potential duplicates and clinical history to resolve patient identification discrepancies, including the necessary investigation of potential identity theft.

 

 

Obtains provider approval to release psychiatric encounter records when requested by the patient and seeks provider approval to release records for minor patients ages 12-17 to parents to comply with additional privacy protections under NC Statute and Federal Law. Accompanies certified copies or original health records to court and the location of scheduled depositions when required. Testifies in court and depositions as to the authenticity of health records containing PHI.

 

Patient identity management Functions: Track, monitor, and validate patient overlays that occur during patient registration and scheduling activities. Analyze and trend data for feedback to the appropriate department. Notifies compliance and affected departments of incorrect documentation location. Coordinates chart correction cases within Maestro Care, including evaluation of help desk requests, assignment of correction tasks, verification of completion and closure of the case, and verifies completion and closure of the case. Maintains an accurate Enterprise Master Patient Index (EMPI) through active research and comparison of potential duplicates and clinical history to resolve patient identification discrepancies, including the necessary investigation of potential identity theft. Performs name and demographic changes with supporting documentation.

 

Performs concurrent and retrospective contact moves. Analyzes the content of the health record document and coordinates with responsible providers, clinicians , and ancillary departments participating in the patient's care for record correction requirements to be resolved. Leads clinical, ancillary, and financial staff to assist in resolving overlay issues of multiple patients in formation in one medical record to resolve overlay within 24 hours of discovery of overlay. Participates in a 24-hour on-call rotation. Maintains enterprise master patient index integrity, medical record number merges, unmerges, and medical record number assignments electronically. Performs name  and demographic changes with supporting documentation. Works with management to compile and review trending reports for patient identity functions. Assists with the preparation of procedure documentation to support processes and training. Performs other duties as assigned, including customer service focus in training providers and internal and external customers on chart correction and support ticket resolution.

Knowledge, Skills and Abilities

 

Good organizational skills, excellent investigative and analytical skills with a detail orientation, and strong follow-through capabilities.Excellent verbal and written communication skills are necessary in order to effectively problem solve, develop working relationships, and assist system users.Must be able to meet deadlines, work independently, set priorities, and maintain confidentiality. Ability to work calmly and efficiently in high-pressure situations. Intermediate knowledge of human anatomy, physiology, and medical terminology is highly preferred. Intermediate to expert skills using Windows-based software and familiarity with information technology hardware and software in a local and wide-area network environment.

 

Level Characteristics

N/A

 

Minimum Qualifications

 

 

Education

High School Diploma required Associate's degree in a Health Information Management or related field preferred

 

Experience

 

Four years of experience in Health Care related field required, two of which must be in Health Information Management Or Candidates with an Associate's degree in HIM require two years of Health Care experience and one year of HIM specific experience or Candidates with a Bachelor's degree in HIM require two years of Health Care experience or Candidates with a Bachelor's degree in Health Care require two years of HIM specific experience

 

Degrees, Licensures, Certifications

 

preferred: RHIT/RHIA/CHPS/CHDA

 

Duke 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 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.

 

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