Boston, Massachusetts
Norfolk, Virginia
Norfolk, Virginia
Fontana, California
Ontario, California
Minneapolis, Minnesota
Posted: 06-Feb-25
Location: Durham, North Carolina
Categories:
Internal Number: 254161
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.
Outpatient Pre-Service Verification is an integral part of the revenue cycle, responsible for overseeing the verification of patient insurance eligibility, prior authorization, and medical necessity forp hysician and hospital outpatient services provided across Duke Health.
This position is responsible for the management of internal/external staff and processes supporting pre-service verification functions while modeling Duke's values and demonstrating expected behaviors. The scope of prior authorization and medical necessity includes but is not limited to, oncology/non-oncology services, infusion, interventional radiology, orthopedics, pediatrics, and labs. The manager is also responsible for the oversight of technical systems supporting automated/real-time authorization(RTA) and medical necessity.
Operational Management 40%
- Drive independent revenue cycle operational decisions to resolve complex issues impacting authorizations, patients, and providers.
- Prepare weekly and monthly reports summarizing operational performance related to service volumes completed, outstanding inventory (work-in-progress), and outcomes of verification related to eligibility/authorization/medical necessity.
- Identify deficiencies in staff performance and inventory backlogs promptly, and take action to address outstanding issues.
- Partner with Patient Account Analysts to monitor authorization and registration denial rates and write off trends to identify and implement opportunities to improve performance.
- Review and approve write-off requests per policy.
- Work proactively and collaboratively with other PRMO management and DUHS identification, research, communication, and process improvement.
- Define criteria and create operational workflows and system work queues to ensure timely and comprehensive verification of eligibility, authorization, and medical necessity for all outpatient visits/services.
- Monitor operational performance and assign/allocate staff to all system work queues to ensure appropriate and equitable resource allocation and prioritization of outstanding workload.
- Communicate with organizational customers/stakeholders to proactively identify and manage performance issues.
Technical Expertise 25%
- Develop and maintain a working and effective knowledge of all operational functions, policies, and procedures performed within the department, related to insurance payor requirements for verification of coverage/eligibility, authorization, and medical necessity.
- Develop and maintain a working knowle dge of the associated technical logic within the Epic system as well as bo lt-on systems supporting eligibility and automated authorizations.
- Develop and maintain work ing and proficient knowledge of personal computer software required for fulfilling management responsibilities, including: Microsoft office (Outl ook, Excel, Word,PowerPoint, etc.), patient accounting systems, IT systems (Service Now Requests),and HR systems (payroll, I-forms,and API PTO).
Staff Management 25%
- Post, recruit, and hire direct reports, and provide orientation to new hires.
- Provide job-specific training to existing direct reports, and ensure that appropriate training is available and provided to staff within the department.
- Ensure that monthly Overall Effectiveness Rating (OER) scores (productivity and quality) are determined for each employee, and feedback is shared with relevant employees and management.
- Conduct mid-year and year-end performance evaluations, and provide appropriate feedback and coaching to direct reports.
- Ensure and monitor online yearly safety and LMS training requirements for staff.
- Identify and implement programs to develop direct reports and associated staff for career development.
- Holds regular team meetings to review performance, share new policies and procedures, and keep employees informed about departmental and PRMO updates.
- Identify and implement opportunities for improvement of staff morale.
- Ensure compliance with all PRMO and DUHS personnel policies.
Policy & Procedure and InternalControls 5%
- Develop and maintain documentation summarizing workflow processes and operating policy& amp; procedure for all functions handled by the team.
- Review changes to all operational processes with the department director before implementation.
- Develop, manage, and monitor internal control performance for all operational processes, and ensure the timely completion of internal control processes by staff on assigned periodic.
Other Managerial Duties 5%
- Prepare and submit for approval an annual budget for the department.
- Reiew actual vs. budgeted variances every month, and provide a summary of explanation to the director.
- 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/guarantor financial data and patient medical data consistent with HIPAA standards.
- Provide coverage for peer managers in her/his absence.
- Other duties as assigned.
Minimum Qualifications
Duke is an Affirmative Action/Equal Opportunity Employer committed toproviding employment opportunity without regard to an indiv idual's age,color, disability, gender, gender expression, gender identit y, geneticinformation, national origin, race, religion, sex, sexual orie ntation,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 contribute ions 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 andDuke University Health System may include essential job f unctions thatrequire specific physical and/or mental abilities. Addition alinformation and provision for requests for reasonable accommodation wi llbe provided by each hiring department.
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.
