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About Duke Health's Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.

The PRMO Revenue Manager serves as a liaison among PRMO, Operational Owners and Maestro Care Clinical/Billing analysts to assist in the design, development, maintenance, training and evaluation for assigned Maestro Care clinical and business systems to support the revenue cycle. This position will be primarily responsible for design/re-design of workflow, working with Maestro Care Build teams, testing, and validating of application functionality specifically related to charge capture/billing. This position will coordinate all revenue cycle issues that arise for their application area and must be very knowledgeable of DUHS/PRMO policies, procedures, and business operations.

Revenue Management

Key Accountabilities

• Manage revenue cycle-related inquiries.
• Serve as Point Person/Service Line Resource (Liaison)
• Respond, research and resolve revenue cycle-related inquiries pertaining to assigned Maestro Care applications.
• Must be able to communicate effectively, provide timely responses, identify resources to resolve inquiries.
• Monitor and manage from key performance indicators.
• Independently complete data analysis.
• Monitor and manage reimbursement changes.
• Interpret and implement items communicated through payer policies.
• Provide training on charge capture, reconciliation, and correction as needed.
• Resolve accounts in assigned Charge Router, Charge Review. Claim Edit, and Follow-Up WQs.
• Monitor and manage key performance indicators.
• Utilize standard reports and/or develop new reports to track revenue cycle performance for assigned application clinical services.
• Areas of focus will include denial rates, avoidable write-off, and full transaction write-offs, deleted charges.
• Will also perform ad hoc analyses as requested, e.g., high- dollar drug reimbursement; service/program/code specific reimbursement; actual charge to budget charge variance.
• Review key metrics, from scheduling to billing & collections, in collaboration with PRMO Managers.
• Identify issues through ongoing monitoring of departmental metrics and/or through routine meetings with key operational managers within PRMO to facilitate communication.
• Monitor & manage reimbursement changes.
• Continuously research and monitor payer regulations; provide education to operational areas.
• As applicable, coordinate with DHIP Revenue Managers to educate physicians to meet changing payer requirements/regulations.
• Other duties as assigned.

Percent of Time

30%

Revenue Cycle Leadership

Key Accountabilities

• Facilitate revenue cycle collaboration and strategic planning activities.
• Serve as Duke Revenue Cycle Management and Integration lead for assigned areas to coordinate activities (reduce redundancies) and keep senior leadership informed.
• Coordinate and chair revenue-oriented workgroup activities and meetings.
• Manage communications among PRMO, hospitals, and physician practices.
• Must be able to facilitate meeting of multi- disciplinary teams.
• Arrange revenue cycle training activities.
• Participate in routine meetings with CFOs, AVP, Reimbursement Revenue Accounting to provide updates on current revenue cycle issues/priorities.
• Provide service line specific strategic planning/priorities to PRMO leadership through Revenue Manager Councils/Operations Meetings.
• Coordinate and chair revenue- oriented workgroup activities and meetings.
• Share operational changes to and from PRMO to hospital and physician practices.
• Develop or participate in focused workgroups to address topics such as registration, billing & collections, coding and charge capture, Maestro Care applications.
• Facilitate discussions and strategies to address operational issues.
• Managing communications between PRMO and Hospital Operational Owners and Providers.
• Organize and lead workgroups to routinely meet with Operations regarding PRMO function, issues, trends, etc., affecting revenue cycle performance.
• Actively participate in service line specific strategic planning around revenue cycle prioritization and planning.
• Arrange revenue cycle training activities.
• Maintain exceptional customer service, fortifying expectation of consistent professionalism and expertise.
• Must be capable of setting priorities and working under pressure.
• Coordinated activities are expected to be carried out with minor supervision.
• Escalate issues as needed.
• Other duties as assigned.

Percent of Time

30%

Project Management

Key Accountabilities

• Manage and prioritize revenue and/or compliance requests.
• Manage projects simultaneously.
• Develop and manage action plans and maintain timelines.
• Organize and keep deadlines.
• Identify and recruit appropriate resources.
• Develop and maintain strong relationships.
• Develop creative solutions.
• Must be process oriented.
• Manage Annual CPT Updates: Coordinate, working with Health System Operations Managers in assigned applications: DUHS Revenue Management and PRMO 

         CDM Team, Hospital Finance, and PDC Revenue Managers; including Annual review of charges and DEPs.

• Investigate and manage revenue opportunities identified through reporting and analysis.
• Other duties as assigned.

Percent of Time

30%

Epic Systems Advisory

Key Accountabilities

• Specialize and manage revenue cycle functions and Epic Systems applications.
• Manage assigned Service Now tickets.
• Must be able to investigate charge and claim information and navigate information systems.
• Serve as EPIC System knowledge source for charge capture functions (charge capture, reconciliation, and corrections for procedures, medications, and supplies as appropriate) with specific applications.
• Other duties as assigned.

Percent of Time

10%

Minimum Qualifications

Ideal candidates will be able to balance the above tasks while maintaining flexible, friendly interaction with Operational and Hospital Leadership. The ability to work independently, proactively and adapt appropriately to changing priorities is a must.

Education

Bachelor's degree required. Master's degree preferred.

Experience

At least 6+ years of relevant Healthcare Care experience preferably in Charge Integrity is required.

Strong leadership capabilities with demonstrated ability to lead, motivate, and collaborate effectively with Hospital leadership.

Strong oral and written communication skills.

Degrees, Licensures, Certifications

Coding certification (e.g. CCS, CPC, RHIA, RHIT), HFMA CHFP (Certified Healthcare Professional), CRCR (Certified Revenue Cycle Representative) preferred.