MANAGER, PATIENT REVENUE

Job description

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 of the Job Class:

Contribute to the achievement of the DUHS mission through the development and leadership of performance improvement activities in the operational and/or clinical arenas. Assure continualcompliance withr egulations and accreditation standards through monitoring activities and the design and implementation of strategies to enhance compliance. Responsible for billing and claims functions and overall managementof the provider enrollment processes associated with enrolling applicable Health Systems and Physicians for all clients. Oversees and coordinates insurance collections and accounts receivable for the purpose of maximizing reimbursement, achieving A/R aging targets,minimizing avoidable/co ntrollable write-offs, and accomplishing results ascost-effectively as possible.

Dutiesand Responsibilities of this Level:

A/R Management

  • Drive independent revenue cycle operational decisions to resolve complex issues impacting collections, patients and providers.

  • Prepare weekly report summarizing inventory statistics, staff productivity and collections performance, and accounts receivable aging trends

  • Identify deficiencies in staff performance and backlogs ininventory statistics in a timely manner, and take actionto address outstanding issues

  • Work with Denials Analyst to monitor denial rate trends, and identify & implement opportunities to reduce post-billing denial rates

  • Review and approve write-off requests per policy. Provide feed back to supervisor and staff if write-off requests are not in compliance with policy requirements

  • Review avoidable write-off trends, and identify & implement opportunities to reduce avoid able write-offs.

  • Work with other PRMO manage ment and DUHS leadership to improve collections, reduce accounts receivable, reduce denial rates, and reduce avoidable write-offs through issue identification, research, communication, and process improvement

  • Pull reports to review aged outstanding insurance accounts receivable, and take necessary action to address backlogs or to identify unworked accounts

  • Define criteria and set up for insurance workfiles/worklists to ensure timely and comprehensive collection of all accounts receivable

  • Assign staff to all insurance workfiles/worklists to ensure appropriate and equitable resource allocation and prioritization to outstanding workload

  • Review daily/weekly/monthly system reports summarizing inventory and staff performance to identify outstanding issues,including:

  • Inventory reports

  • Interrupt/Tickle/Hold reports

  • Activity Code Utilization reports

  • Provider Enroll ment status reports

  • Workgroup issue log main tenance

  • Prepare operational status updates on High Balance accounts for weekly management meeting and review

  • Prepare a monthly summary of accounts receivable by entity/division/payorfor senior manager and director review,with explanation for changes in performance and specific plans to address deficiencie s

  • Research operational and system issues identified by collectors,and develop/implement solutions for performance im provement

Staff Management

  • Oversee supervisor’s efforts in posting, recruiting, and hiring new employees

  • Oversee supervisor’s efforts to provide job-specific training to new and existing employees

  • Oversee supervisor’s mid-year and year-end performance evaluationsof employees

  • Post, recruit, and hire direct reports (supervisors)

  • Provide job-specific training to new and existing direct reports

  • Conduct mid-year and year-end performance evaluations and provide feedback to direct reports

  • Review results of monthly employee quality reviews, and take action on under performing staff results

  • Ensure that all provider enrollment processes are completed inanaccurate, timely manner and that credentials are up to date

  • Oversee the claims billing and provider enrollment workgroupfunction s to ensure appropriate logic in place for revenue success

  • Oversee all revalidations and reverifications related toe nrollment to ensure timely completion

  • Support the supervisor in oversight of completing enrollment packets for providers and groups in an accurate and timely manner

  • Assist with the development of job specific training programs for all staff within team

  • Identify and implement programs to develop direct reports and associated staff forcareer development

  • Hold monthly team meetings to review team performance, share new policy and procedures, and keep employees informed about PRMO updates

  • Identify and implement opportunities for improvement of staffmorale

  • Ensure compliance with all PRMO and DUHS personnel policies

Policy & Procedure and Internal Controls

  • Develop and maintain documentation summarizing workflow processe sand operating policy & procedure for all functions handled by team.

  • Document and review changes to all operational processes with department senior manager and director prior to implementation.

  • Develop internal controls for all operational processes, and ensure the timely completion of internal control processes by staff,supervisor, and manager on assigned periodic basis

Managerial Duties

  • Prepare and submit for approval an annual budget for the team

  • Review actual vs. budgeted variances on a monthly basis, and provide summary of explanation to senior manager and director

  • Identify negative budget variances, and provide explanation and game plan for addressing deficiencies

  • Identify opportunities to reduce or minimize personnel and non-personnel costs

  • Respond to inquiries from PRMO and DUHS leadership, peers, andstaff in a timely, accurate, and comprehensive manner (ie: 24-48 hours,depending on circumstances)

  • Adhere to all PRMO and DUHS revenue cycle policies and regulations

  • Respect and maintain confidentiality regarding patient/ guarantor financial data and patient medical data consistent with HIPAA standards

  • Validate and reassess productivity standards through observations,documenting and sharing for management review and recommendresolution/feedback.

  • Provide coverage for Director in her/his absence

  • Provide coverage for Supervisor in her/his absence

  • Responsibility for all supervisor respo nsibilities on smaller teams that do not have supervisor

  • Establish and maintain a network of key contacts from provider representatives to senior level management with various carriers and departments to expedite and encourage effective enrollment and billing execution

  • Assure that the department tracks and follows through on provider documents that are set to expire and notify customers timely

  • Other duties as assigned
Technical Expertise
  • Develop and maintain a working and effective knowledge of all functions performed by team

  • Develop and maintain a working knowledge of relevant payor billing requirements and reimbursement regulations

  • Interpret and an analyze data associated with Provider Enrollment payer regulations, keeping up with all mandates

  • Develop and maintain a working knowledge of all core systems(Epic) and ancillary systems (Avail ity, SAP, ECHO, Hyland, Cognos/ReportNet)utilized by team

  • Develop and maintain complete understanding of all operati onalpolicies and procedures relevant to team

  • Develop and maintain working and proficient knowledge of personal computer software required for fulfilling management responsibilities, including : Lotus Notes, Excel spreadsheets, Word processing, Access database, Visio flowchart, Powerpoint presentation, TeamTrack Change Cont rols, Pillar budget, SAP, I-forms, and APIPTO

Minimum Qualifications

Education

Bachelors degree required. Masters degree preferred.

Experience

Work requires 5 years of experience in business or other applicable experience. A master's degree in a related field, such as business or health administration, may be substituted for experience on a 1:1 basis.

Degrees, Licensures, Certifications

Certifications in patient access or patient accounting preferred.

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.

 

 

 

Diversity Profile: University

 

AAUP COMPENSATION SURVEY DATA

View more

Learn more on Inside Higher Ed's College Page for University

Arrow pointing right
Job No:
Posted: 10/6/2020
Application Due: 1/4/2021
Work Type:
Salary: