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REVENUE MANAGER - INPATIENT

Employer
Duke University
Location
FOCUSED CODING INPATIENT RISK

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Employment Type
Full Time
Institution Type
Four-Year Institution

Job Details

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: The IP Risk Revenue Manager will oversee activities associated with Hospital Coding and quality, value based purchasing and IP Risk Adjustment.

JOB RESPONSIBILITIES:

Manage and coordinate activities for all Hospital Coding projects that are related to quality, value based purchasing and IP Risk Adjustment. Projects included but not limited to; Mortality Reviews, Service Line Reviews, Patient Safety Indicators, etc.

Continuously research and monitor payer regulations and quality methodologies; provide education to operational areas as applicable.

Coordinate with service line leaders to educate physicians; facilitated implementation of modifications to revenue cycle functions to meet changing payer requirements/regulations, e.g., new authorization requirements; changes in billing/claims requirements; LCDs. Coordinate strategies through Bulletin Review and other resources.

Facilitate Revenue Manager training around work/skills or career development topics (e.g., Report writing, Branding & Marketing, Communications, Project Management, Onboarding, Compliance/Regulation Interpretation, HL7 interfaces; how WQ logic works).

Develop and prepare/utilize reports to track operational performance across various quality /risk adjustment projects within Hospital Coding.

Investigate and manage revenue opportunities identified through reporting and analysis.

Perform root cause analysis and provide expert and creative solutions. Actions to be taken to achieve resolution include:

  • Assemble cross-functional team within PRMO (if applicable), Develop Revenue cycle-related project plan, maintain comprehensive issues lists with time lines and responsibilities clearly assigned, escalate issues through PRMO Senior Operational Leaders that require significant cross-departmental resources.
  • Assist in the development of reengineered best practice workflow processes and identify system optimization that improves revenue cycle performance

Work with revenue management, department, and PRMO operational managers to ensure newly implemented workflows and procedures support revenue cycle integrity.

Serve as EPIC System knowledge source for documentation, coding and charge capture functions (charge capture, reconciliation, and corrections for procedures, medications, and supplies as appropriate) with specific applications (interface between Maestro & PRMO claims processing needs)

Coordinate all Maestro Care revenue cycle-related system setup/modifications necessary to bring up new services. Manage to completion. Specific functions include but not limited to:

  • Work with Maestro Care trainers and administrative leadership (operations, medical directors, etc.,) to educate and train providers and staff about new services; specifically charge capture and their role related to revenue cycle
  • Work with Maestro Care Teams to implement service-specific charge-capture methodology.
  • Work with PRMO/Maestro Care professional and/or technical billing teams to determine need for/request updates to charge router logic; charge review logic/work queue definition; claim logic
  • Immediately after go-live of new services, validate revenue cycle functions operating as expected: confirming accurate billing; monitoring specific patient examples for denials/payments.
  • Notify other PRMO operational areas of new service so they can determine what, if any changes are required, e.g., provider enrollment; service access/preregistration.

Attend Quality/IP Risk Adjustment meetings with providers and service line leaders; provide updates regarding outcomes of quality related projects.

Review and compile summaries based on clinical and quality reviews of the following areas:

Mortality Reviews, DIHI Reviews, 30-day Death Reviews, REM Second Level Reviews, Fair Code Reviews etc.

Acts as a liaison between providers and operational management for all inpatient quality/risk functions.

Facilitates revenue cycle collaboration and service line specific strategic planning activities

Review and recommend changes/updates to the department workflows to maximize efficiency within the group.

Review key metrics from Performance Services, Vizient and external agencies, in collaboration with PRMO Managers and Providers.

Participate in routine meetings with CFOs, AVPs, and other Departmental and Revenue Cycle to provide updates on current revenue cycle issues/priorities.

Perform other related duties incidental to the work described herein.

Required Qualifications at this Level:

Education:

Bachelor’s degree required. Master’s degree preferred.

Experience:

Six years of experience in the healthcare industry is required.

Thorough understanding of IP Risk methodologies; Vizient, Elixhauser, USNWR rankings, PSI initiatives etc.

Degrees, Licensure, and/or Certification:

BA, BBA, RN, CPC/CCS, RRA, or CPA, RHIT or RHIA or higher

Knowledge, Skills, and Abilities:

Experience in these areas is preferred: Coding, Auditing, Quality Reviews (Mort/PSI/Service Line). Must have understanding of USNWR rankings, and EPIC logic.

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.

Organization

Read our Diversity Profile History

Duke University was created in 1924 by James Buchanan Duke as a memorial to his father, Washington Duke. The Dukes, a Durham family that built a worldwide financial empire in the manufacture of tobacco products and developed electricity production in the Carolinas, long had been interested in Trinity College. Trinity traced its roots to 1838 in nearby Randolph County when local Methodist and Quaker communities opened Union Institute. The school, then named Trinity College, moved to Durham in 1892, where Benjamin Newton Duke served as a primary benefactor and link with the Duke family until his death in 1929. In December 1924, the provisions of indenture by Benjamin’s brother, James B. Duke, created the family philanthropic foundation, The Duke Endowment, which provided for the expansion of Trinity College into Duke University.Duke Campus

As a result of the Duke gift, Trinity underwent both physical and academic expansion. The original Durham campus became known as East Campus when it was rebuilt in stately Georgian architecture. West Campus, Gothic in style and dominated by the soaring 210-foot tower of Duke Chapel, opened in 1930. East Campus served as home of the Woman's College of Duke University until 1972, when the men's and women's undergraduate colleges merged. Both men and women undergraduates now enroll in either the Trinity College of Arts & Sciences or the Pratt School of Engineering. In 1995, East Campus became the home for all first-year students.

Duke maintains a historic affiliation with the United Methodist Church.

Home of the Blue Devils, Duke University has about 13,000 undergraduate and graduate students and a world-class faculty helping to expand the frontiers of knowledge. The university has a strong commitment to applying knowledge in service to society, both near its North Carolina campus and around the world.

Mission Statement

Duke Science"James B. Duke's founding Indenture of Duke University directed the members of the University to 'provide real leadership in the educational world' by choosing individuals of 'outstanding character, ability, and vision' to serve as its officers, trustees and faculty; by carefully selecting students of 'character, determination and application;' and by pursuing those areas of teaching and scholarship that would 'most help to develop our resources, increase our wisdom, and promote human happiness.'

“To these ends, the mission of Duke University is to provide a superior liberal education to undergraduate students, attending not only to their intellectual growth but also to their development as adults committed to high ethical standards and full participation as leaders in their communities; to prepare future members of the learned professions for lives of skilled and ethical service by providing excellent graduate and professional education; to advance the frontiers of knowledge and contribute boldly to the international community of scholarship; to promote an intellectual environment built on a commitment to free and open inquiry; to help those who suffer, cure disease, and promote health, through sophisticated medical research and thoughtful patient care; to provide wide ranging educational opportunities, on and beyond our campuses, for traditional students, active professionals and life-long learners using the power of information technologies; and to promote a deep appreciation for the range of human difference and potential, a sense of the obligations and rewards of citizenship, and a commitment to learning, freedom and truth.Duke Meeting

 “By pursuing these objectives with vision and integrity, Duke University seeks to engage the mind, elevate the spirit, and stimulate the best effort of all who are associated with the University; to contribute in diverse ways to the local community, the state, the nation and the world; and to attain and maintain a place of real leadership in all that we do.”

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