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Posted: 17-Jan-25
Location: Durham, North Carolina
Categories:
Internal Number: 253473
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
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.
Please 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 continual compliance with regulations and accreditation standards through monitoring activities and the design and implementation of strategies to enhance compliance. Responsible for billing and claims functions and overall management of the provider enrollment processes associated with enrolling applicable Health Systems and Physicians for all clients. Oversee and coordinate Provid er Enrollment professional and hospital insurance collections and accounts receivable to maximize reimbursement, achieve A/R aging targets, minimize avoidable/controllable write-offs, and accomplish results as cost-effectively as possible.
- < li>Drive independent revenue cycle operational decisions to resolve complex issues impacting collections, patients, and providers. < /li>
- Prepare a weekly report summarizing inventory statistics, staff productivity and collections performance, and accounts receivable aging trends
- Identify deficiencies in staff performance and backlogs in inventory statistics promptly, and take action to 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 feedback to supervisor and staff if write-of requests are not in compliance with policy requirements
- Review avoidable write-off trends and identify & implement opportunities to reduce preventable write-offs.
- Work with other PRMO management 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 insurance work files/work sts to ensure the timely and comprehensive collection of all accounts receivable
- Assign staff to all insurance work files/work sts to ensure appropriate and equitable resource allocation and prioritization of outstanding workload
- Review daily/weekly/ monthly system reports summarizing inventory and staff performance to identify outstanding issues, including:
- Inventory reports
- Provider Enrollment status reports
- Issue log maintenance
- Prepare operational status updates on High Balance accounts for the weekly management meeting
- Prepare a monthly summary of accounts receivable by provider/payor for director review, with an explanation for changes in performance and specific plans to address deficiencies
- Research operational and system issues identified by staff, and develop/ implement solutions for performance improvement
- 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 evaluations of employees
- Post, recruit, and hire direct reports (supervisors and reimbursement t specialists)
- 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 underperforming staff results
- Ensure that all provider enrollment processes are completed in an accurate, timely manner and that credentials are up to date
- Oversee the claims billing and provider enrollment functions to ensure appropriate logic in place for revenue success
- Oversee all revalidations and verifications related to enrollment 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 the team
- Identify and implement programs to develop direct reports and associated staff for career development
- Hold monthly team meetings to review team performance, share new policies and procedures, and keep employees informed about PRMO updates
- Identify and implement opportunities for improvement of staff morale
- Ensure compliance with all PRMO and DUHS personnel policies
- Develop and maintain documentation summarizing workflow processes and operating policy & procedure for all functions handled by the team.
- Document and review changes to all operational processes with the director before implementation.
- Develop internal controls for all operational processes, and ensure the timely completion of internal control processes by staff, supervisor, and manager on an assigned periodic basis
- Prepare and submit for approval an annual budget for the team
- Review actual vs. budgeted variances every month, and provide a summary of explanation director< /span>
- Identify negative budget variances, and provide an explanation and gameplan for addressing deficiencies
- I identify 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: 24-48 hours, depending on circumstances)
- Adhere to all PRMO and DUHS revenue cycle policies and regulations
- Respect and maintain confidentiality regarding patient/ guara ntor financial data and patient medical data consistent with HIPAA standards
- Validate and reassess productivity standards through observations, documenting, and sharing for management review and recommend resolution/feedback.
- Provide coverage for the Director in her/his absence
- Provide coverage for S supervisor in her/his absence
- Responsibility for all supervisor responsibilities for staff that do not report to the supervisors
- Establish and maintain a network of key contacts ts 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
- Develop and maintain a working and effective knowledge of all functions performed by a team
- Develop and maintain a working knowledge of relevant payor billing requirements and reimbursement regulations
- Interpret and analyze data associated with Provider Enrollment payer regulations, keeping up with all mandates
- Develop and maintain a working knowledge of all core systems (CredentialStream, Echo, Epic) and ancillary systems (SAP, Hyland, etc.) utilized by the team
- Develop and maintain a complete understanding of all operational policies and procedures relevant to the team
- Develop and maintain working and proficient knowledge of personal computer software required for fulfilling management responsibilities, including Outlook, Sharepoint, Microsoft 365 applications (Teams, Lists, Planner, Excel, Word, Powerpoint, etc.), ServiceNow, SAP, I-forms, and API PTO< /span>
Minimum Qualifications
Education
Bachelor's degree required. Master's 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 are 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.
