Reimbursement Specialist

North Carolina, United States
16 Oct 2018
End of advertisement period
16 Dec 2018
Contract Type
Full Time


Job Description

Strongly Preferred Qualifications:

Front End Registration Experience Epic/Maestro Care Experience

General Description of the Job Class:

  • Perform quality assurance reviews of accounts which impact revenue cycle activities as well as adherence to compliance and regulatory requirements
  • Compile, analyze and report on QA performance of departmental operating units, noting trends and making recommendations or conclusions which are in alignment with the financial performance of the Health System.
  • Review financial reporting and trends impacting reimbursements/cash projections (denials/write offs/performance dashboards); coordinate projects and quality assurance reviews based on trends; provide workflow recommendations for discovered deficiencies to improve reimbursement/cash projections
  • Track financial performance related to changes in workflow and/or recommendations
  • Provide front end registration coverage to outpatient clinics in conjunction with the PRMO outpatient clinic float pool.

Quality Assurance Reviews:

  • Perform quality assurance reviews of arrived patient encounters based on assigned clinics and/or area(s) of focus.
  • Maintain documentation of quality assurance scores and trends, in accordance with compliance guidelines as it relates to the file maintenance, retention and PHI requirements.
  • Compile, analyze and report findings of departmental units; noting conclusions, trends and recommendations based on any identified deficiencies and/or opportunities for improvement to help support revenue cycle activities and reimbursements
  • Analyze data and provide feedback to individual departments for departmental specific reports and/or staff re-education opportunities
  • Review financial reporting and trends impacting the overall financial performance of the Health System (i.e. denials/write offs/performance dashboards)
  • Coordinate projects and quality assurance reviews based on financial reporting and trends negatively impacting reimbursements/cash (denials/write offs/compliance and/or regulatory requirements); provide recommendations to local and/or departmental leadership based off identified deficiencies and/or opportunities for improvement
  • Track financial performance related to operational workflow changes to ensure positive financial results based on these changes
  • Review and analyze accounts to ensure adherence with compliance and regulatory requirements (i.e. MSPQ, HITECH, COA/COT, Family Planning Medicaid) which have potential negative financial implications to the Health System
  • Meet assigned deadlines
  • Participate in Service Access training opportunities to ensure up to date knowledge of system and workflow changes
  • Perform quality assurance reviews independently with minimal supervision
  • Utilize front end registration knowledge to ensure accurate analysis of accounts reviewed
  • Assist in developing and defining short and long term departmental specific goals and objectives.

Front End Registration Coverage:

  • Provide front end registration coverage to outpatient clinics in conjunction with the PRMO outpatient clinic float pool.
  • Perform the duties as described in the Patient Service Associate /Financial Care Counselor job description to maintain outpatient registration competencies as part of their quality assurance review responsibilities.
  • Demonstrate expected behaviors which contribute to a positive patient experience.


  • Attends meetings and participates on committees, as assigned.
  • Develop and provide job-specific training to new and existing employees within the department.
  • Perform all other related duties incidental to the work described herein.
  • Accomplishes all tasks as appropriate.
  • Living Duke’s Values by demonstrating expected behaviors, contributing to a positive work environment

Requisition Number 401494761
Location Durham
Duke Entity PRMO
Job Family Level D2
Exempt/Non-Exempt Non-exempt
Full Time / Part Time FULL TIME
Regular / Temporary Regular
Shift First/Day

Minimum Qualifications

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.


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


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

Degrees, Licensures, Certifications


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