MANAGER, PATIENT REVENUE - HOSPITAL COLLECTIONS MANAGEMENT
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.
Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Manager, Patient Revenue who will embrace our mission of Advancing Health Together.
Duties and Responsibilities of this Level:
Prepare weekly kpi report summarizing inventory statistics, staff productivity and collections performance, and accounts receivable aging trends
Work with Denials Analyst to monitor denial rate trends, and identify & implement opportunities to reduce denial rates.
Work without sourcing vendors to monitor performance around insurance collections and accounts receivable management to improve overall performance and prevention of backend billing denials, coding denials or other AR concerns.
Review and approve higher dollar write-off requests per policy.
Provide feedback to supervisor and staff if write-of requests are not in compliance with policy requirements.
Review avoidable write-off trends; implement opportunities to reduce avoidable write-offs.
Work with PRMO management and DUHS leadership to improve collections, reduce accounts receivable, reduce claim edits, improve clean claim rate, 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 via system enhancements, payor escalation, staff retraining, or changes to operational workflows and policy/procedure.
Contact PRMO Payor Relations and/or relevant payor leadership to escalate and address outstanding insurance collections issues for higher dollar and aged accounts, as necessary.
Review weekly/monthly system reports summarizing inventory and staff performance to identify and address outstanding issues, including: Inventory reports, Tickler/Defer/Hold reports, Activity Code Utilization reports , and Dashboard reports.
Prepare operational status updates on High Balance accounts for weekly management meeting, to identify and implement opportunities for improvement in workflows and policies.
Prepare a monthly summary of accounts receivable by entity/division/payor, with explanation for change s in performance and specific plans to address deficiencies.
Review research of operational and system issues conducted by supervisors and staff, and develop/implement solutions for performance improvement.
Review current issue log of all trends and system tickets maintained by supervisors and analysts, and monitor weekly to ensure appropriate escalation and timely/thorough resolution
Maintain a working knowledge of relevant industry and payor requirements related to insurance collections: federal/state compliance statutes, payor collections rules, and reimbursement regulations through a proactive, thorough, and timely review of payor bulletins, websites, conferences, onsite visits, and other communications.
Maintain a working knowledge of all core systems (EPIC) and ancillary systems (Availity, SSI, Hyland) related to insurance collections.
Maintain a working knowledge of all operational functions performed by team, and the associated operational policies/procedures.
Oversee changes to operational workflows, and ensure submission of related system changes, to comply with changes in industry and payor requirements related to insurance collections in a timely manner.
Maintain documented issue log of all insurance collections system tickets, enhancements, changes to include present status and other department involvement.
Oversee all testing related to all insurance collections system tickets to ensure accuracy, and post-implementation success.
Communicate any operational and system changes relevant to insurance collections to relevant PRMO and Duke Medicine constituencies.
Research and address technical questions from Duke Medicine constituencies related to insurance collections and accounts receivable management.
Post, recruit, and hire direct reports.
Provide job-specific training to direct reports.
Conduct mid-year and year-end performance evaluations and provide feedback to direct reports.
Oversee and support supervisors efforts in posting, recruiting, and hiring new employees.
Oversee and support supervisors efforts to provide job-specific training to new and existing employees.
Oversee and support supervisors mid-year and year-end performance evaluations of employees.
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 for career development.
Identify and implement opportunities for improvement of work culture and employee engagement.
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.
Identify and implement opportunities to reduce or minimize personnel and non-personnel costs.
Respond to inquiries from PRMO and DUHS leadership, peers, and staff in a timely, accurate, and comprehensive manner (ie: 24-72 hours, depending on circumstances).
Ensure department compliance with all PRMO and DUHS revenue cycle, human resources, and administrative policies and regulations.
Respect and maintain confidentiality regarding patient/guarantor financial data and patient medical data consistent with HIPAA standards.
Provide coverage for Director in her/his absence, and provide coverage for Supervisor in her/his absence.
Develop and maintain documentation summarizing workflow processes and operating policy & procedure for all functions handled by team.
Review and approve all material changes to operational workflows and system processes.
Develop and oversee adherence to internal controls for all operational processes.
Maintain working and proficient knowledge of personal computer software required for fulfilling management responsibilities, including: Outlook, Excel spreadsheets, Word processing, Visio flowchart, Powerpoint presentation, Team Track Change Controls, Pillar budget, Kenexa, I-forms, and Report Express PTO.
Other duties as assigned
Bachelor’s degree required. Master’s degree preferred.
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.