Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is the 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 for Duke Health.

General Description of the Job Class

Reporting to the PRMO Senior Revenue Manager, the revenue manager coordinates activities performed by the staff responsible for charge capture, coding, charge entry, insurance follow-up, reimbursement analysis, or other PRMO functions within the assigned clinical area. Monitor performance for staff responsible for appointment scheduling, registration, clinic check-in, and clinic collections. Develop and prepare/utilize reports to track financial and operational performance across the entire spectrum of the revenue cycle for the assigned clinical area. Review and recommend changes/updates to the department's charge master(s) to maintain fees at levels that maximize reimbursement. Review and recommend changes to the department's charge capture documents to facilitate accurate and comprehensive billing in compliance with annual CPT/HCPCS and ICD-10 updates. Identify revenue cycle problems, research/analyze data to resolve issues, identify and select alternatives to address outstanding issues, and implement solutions for improvement. Work with financial analysts, physicians, and administrative leadership to educate and train providers and staff about coding and other outstanding revenue cycle issues. Act as a liaison to management and staff in the designated clinical area, Patient Revenue Management Organization (PRMO); Duke University Health System (DUHS); Duke Health Integrated Practice; and third-party payers on revenue cycle activities for assigned areas. Continuously research, monitor, provide education and implement payer regulations and guidelines related to revenue management activities of the assigned clinical area. Coordinate revenue management orientation and educational activities of clinical personnel, including providers and staff about coding and other outstanding revenue cycle issues. Develop and utilize management models to monitor productivity and quality of staff performance. Train, direct, and coordinate activities of assigned financial analysts /or other employees. Perform other related duties incidental to the work described herein.

The PRMO Revenue Manager serves as a liaison among PRMO, Operational Owners and Maestro Care Clinical/Billing analysts to assist in the design, development, maintenance, training and evaluation for assigned Maestro Care clinical and business systems to support the revenue cycle. This position will be primarily responsible for design/re-design of workflow, working with Maestro Care Build teams, and testing and validating of application functionality specifically related to charge capture/billing. This position will coordinate all revenue cycle issues that arise for their application area and must be very knowledgeable of DUHS/PRMO policies, procedures, and business operations.

Duties and Responsibilities of this Level

Revenue Management - 40% of Time

Key Accountabilities -Revenue Management

• Duty Statement:
  • Manage revenue cycle-related inquiries
  • Monitor & manage from key performance indicators
  • Monitor & manage reimbursement changes
• Performance Standards:
  • Must be able to communicate effectively, provide timely responses, identify resources to resolve inquiries
  • Must be able to perform data analysis
    • Must be able to interpret policies

Revenue Cycle Leadership - 30% of Time

Key Accountabilities - Revenue Cycle Leadership

• Duty Statements
  • Facilitate revenue cycle collaboration and strategic planning activities
  • Coordinate and chair revenue-oriented workgroup activities and meeting
  • Manage communications among PRMO, hospitals, and physician practices
  • Arrange revenue cycle training activities
• Performance Standards
  • Coordination of activities are expected to be carried out with minor supervision
  • Must be capable of setting priorities and working under pressure
  • Must be able to facilitate meeting of multi-disciplinary teams
  • Must be able to understand basics of topics

Project Management- 20% of Time

Key Accountabilities - Project Management

• Duty Statements

• Manage and prioritize revenue and/or compliance requests
• Develop and manage action plans & timelines
• Identify and recruit appropriate resources
• Develop creative solutions

• Performance Standards
  • Must be able to manage projects simultaneously
  • Must be able to organize and keep deadlines
  • Must be able to develop strong relationships
  • Must be able to process oriented

Epic Systems Advisory - 10% of Time

Key Accountabilities - Project Management

• Duty Statements
  • Specialize & manage revenue cycle functions and Epic Systems applications
• Performance Standards
  • Must be able to investigate charge and claim information, and navigate information systems

Specific Job Duties/Key Accountabilities

Revenue Management - 40% of Time

1. Manage revenue cycle-related inquiries
   1. Serve as Point Person/Service Line Resource (Liaison)
   2. Respond, research and resolve revenue cycle-related inquiries pertaining to assigned MC applications
   3. Manage assigned Service Now tickets
2. Specialize & manage revenue cycle functions and Epic Systems applications
   1. Serve as EPIC System knowledge source for charge capture functions (charge capture, reconciliation, and corrections for procedures, medications, and supplies as appropriate) with specific applications (interface b/w Maestro & PRMO claims processing needs)
   2. Provide training on charge capture, reconciliation, and correction as needed
   3. Resolve accounts in assigned Charge Router, Charge Review. Claim Edit, and Follow-Up WQs
3. Monitor & manage from key performance indicators
   1. Utilize standard reports and/or develop new reports to track revenue cycle performance for assigned applications clinical services. Areas of focus will include denial rates, avoidable write-off, and full transaction write-offs; deleted charges. Will also perform ad hoc analyses as requested, e.g., high-dollar drug reimbursement; service/program/code specific reimbursement; actual charge to budget charge variance
   2. Review key metrics from scheduling to billing & collections, in collaboration with PRMO Managers
   3. Identify issues through ongoing monitoring of departmental metrics and/or through routine meetings with key operational managers within PRMO to facilitate communication.
4. Monitor & manage reimbursement changes
   1. Continuously research and monitor payer regulations; provide education to operational areas as applicable; coordinate with PDC revenue managers 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.
   2. Monitor payer regulations & coordinate strategies through Bulletin Review and other resources

Revenue Cycle Leadership- 30% of Time

1. Facilitate revenue cycle collaboration and strategic planning activities
   1. Serve as Duke Revenue Cycle Management & Integration lead for assigned areas to coordinate activities (reduce redundancies) and keep senior leadership informed
   2. Participate in routine meetings with CFOs, AVP, Reimbursement Revenue Accounting to provide updates on current revenue cycle issues/priorities
   3. Providing service line specific strategic planning/priorities to PRMO leadership through Revenue Manager Councils/Operations Meetings
2. Coordinate and chair revenue-oriented workgroup activities and meeting
   1. Share operational changes to/from PRMO to hospital and physician practice
   2. Develop or participate in focused workgroups to address topics such as registration, billing & collections, coding and charge capture, Maestro Care applications
   3. Facilitate discussions and strategies to address operational issues
   4. Escalate issues as needed
3. Manage communications among PRMO, hospitals, and physician practices
   1. Managing communications between PRMO and Hospital Operational Owners and Providers
   2. Organize and lead workgroups to routinely meet with Operations regarding PRMO function, issues, trends, etc., affecting revenue cycle performance
   3. Actively participate in service line specific strategic planning around revenue cycle prioritization and planning
4. Arrange revenue cycle training activities
   1. Coordinate training for non-charge capture revenue cycle topics as needed
   2. 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)

Project Management - 20% of Time

1. Manage revenue and/or compliance requests
   1. Manage request-based Revenue Enhancement and/or Compliance process improvement Projects (e.g., New, Modified, and Discontinued Services Request Management, including new services and locations
   2. Manage routine-based: Annual CPT Updates: coordinate, working with Health System Operations Managers in assigned applications: DUHS Revenue Management and PRMO CDM Team, Hospital Finance, and PDC Revenue Managers; including Annual review of charges and DEPs
   3. Investigate and manage revenue opportunities identified through reporting and analysis
2. Develop and manage action plans & timelines
   1. Perform root cause analysis and provide expert and creative solutions. Actions to be taken to achieve resolution include:
   2. 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.
   3. Assist in the development of re-engineered best practice workflow processes and identify system optimization that improves revenue cycle performance
   4. Work with revenue management, department, and PRMO operational managers to ensure newly implemented workflows and procedures support revenue cycle integrity
   5. Coordinate all Maestro Care revenue-cycle related system set-up/modifications necessary to bring up new services. Manager to completion. Specific functions include but not limited to:
3. Identify and recruit appropriate resources
   1. 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
   2. 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
   3. Immediately after go-live of new services, validate revenue cycle functions operating as expected: confirming accurate billing; monitoring specific patient examples for denials/payments.
   4. Notify other PRMO operational areas of new service so they can determine what, if any changes are required, e.g., provider enrollment; service access/pre-registration
   5. Example subjects:
      1. Master File creation record creation/updates: billing provider record (SER), department Record (DEP) bill area record (BIL), and charge codes (EAP)
      2. New charge code creation (as applicable) - assist department operational manager in determining if new charges codes are needed (department manager submits request)
      3. Charge capture methodology validation/updates - specific tasks dependent on charge capture method employed: update charging preference lists; work with Maestro Care application owner to update flowsheets; create/update orderable; confirm linked chargeable; work with PRMO coding Staff to ensure awareness of new services/charge codes;
4. Develop creative solutions
   1. Utilize knowledge in revenue cycle and system applications to investigate root causes of problems, and guide process to fix issues
   2. Lead multi-disciplinary teams in brainstorming activities to develop sustainable solutions to emergent and long-standing problems

Epic Systems Advisory- 10% of Time

1. Specialize & manage revenue cycle functions and Epic Systems applications
   1. Must be able to investigate charge and claim information, and navigate information systems

Required Qualifications at this Level

Education:

Bachelor's degree required. Master's degree preferred.

Experience:

At least 6+ years of relevant Healthcare Care experience preferably in Charge Integrity/Revenue Management is required.

Degrees, Licensure, and/or Certification:

Coding certification (e.g. CCS, CPC, RHIA, RHIT), HFMA CHFP (Certified Healthcare Professional), CRCR (Certified Revenue Cycle Representative), or BSN RN preferred.

Knowledge, Skills, and Abilities:

Strong leadership capabilities with demonstrated ability to lead, motivate, and collaborate effectively with Hospital leadership.

Strong oral and written communication skills.

Excellent problem solving, analytical, and technical troubleshooting skills.

Prioritization skills and ability to manage multiple projects concurrently.

Ability to work on a flexible schedule

Strong research and documentation skills.

Ability to work independently

Intermediate to expert in Microsoft Excel, PowerPoint, Teams, Word, Visio and Outlook