REIMBURSEMENT SPECIALIST - PROVIDER ENROLLMENT
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 Reimbursement Specialist who will embrace our mission of Advancing Health Together. General Description of the Job Class
Record and generate variety of information pertaining to the patient revenue process. Accurate, high-performance level position requires certain degree of knowledge of complex rules and corresponding ability to apply these rules in the work environment to achieve desired outcomes.
Duties and Responsibilities of this Level
- Analyze and provide feedback for departmental specific reports.
- Utilizes clinical and coding knowledge to ensure accurate and compliant charge items and to recognize and resolve billing inconsistencies.
- Coordinates projects and audits to improve processes related to revenue cycle, efficiency of charging and billing, and collection efforts.
- Assist management in forecasting by providing historical information. Work with departmental directors, managers and appropriate personnel to ensure budgetary compliance.
- Manage appropriate systems for accounts receivable and/or financial reporting and prepare written reports and analyses for PRMO, DUHS and PDC leadership documenting trends and appropriate recommendations/conclusions.
- Coordinate communication between insurance companies, governmental agencies, providers and support staff.
- Trend and report on departmental performance indicators and goals. Ensure departmental goals are satisfied.
- Make recommendations to improve financial systems; perform in house audits of operating units; analyze deficiencies and report to manager/director.
- Assist in developing and defining short and long term departmental specific goals and objectives.
- May be responsible for managing and delegating database inquiries. Creation and development of work assignments including training of employees.
- Maintain professional relationship with internal and external agencies and professional organizations concerning operations.
- May serve as liaison between the physicians and the PRMO.
- May conduct employee quality reviews in support of OER (Overall Effectiveness Rating) performance evaluations, and provide feedback to management and relevant employees.
- Develop and provide job-specific training to new and existing employees within department.
- Perform other related duties incidental to the work described herein.
Required Qualifications at this Level:
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, Licensure, and/or Certification
Knowledge, Skills, and Abilities
Excellent communication skills, oral and written. Ability to analyze data, perform multiple tasks and work independently. Must be able to develop and maintain professional, service-oriented working relationships with patients, physicians, co-workers and supervisors. Must be able to understand and comply with policies and procedures.
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.
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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.