MANAGER, PATIENT REVENUE

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.

Job Title: Manager, PRMO Self-Pay, Payer Relations & Customer Service Support

General Description of the Job Class:

Maintains oversight of and coordinates Self-Pay accounts receivable & Bad-Debt collections for the purpose of maximizing patient liability reimbursement, achieving A/R aging targets, minimizing avoidable/controllable write-offs, and accomplishing results as cost-effectively as possible.

Leads efforts to research and resolve strategic and operational issues between payers and revenue cycle operations within the Patient Revenue Management Organization, including ensuring compliance with all payer-related regulations through review, distribution, and communication of payer bulletins.

Work with other PRMO management and DUHS leadership stakeholders to improve processes, reduce accounts receivable, reduce days in receivables outstanding, and avoidable write-offs through issue identification, research, communication, and collaborative process improvement

·         Monitor reports to validate aging Hyland workflows, vendor workflows, and statement workflows, and take necessary action to address backlogs or to identify unworked accounts

·         Define criteria and working parameters to ensure the timely and comprehensive collection of all outstanding accounts receivable

·  Assign staff to all working parameters relevant to Self-Pay books of business 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

Work queues/workflow monitoring reports

Activity Code Utilization Reports

Hyland workflow

CRM workflow

·          Prepare a monthly summary of A/R by entity/division/payor for director review, with explanation for changes in performance and specific plans to address deficiencies/inflated liabilities

·          Research operational/system issues identified by Bad Debt vendors and develop/implement solutions for performance improvement

Management of the Relationship between PRMO and Payors (30%)

·         Represent the PRMO in meetings and discussions with payors about revenue cycle performance and issue resolution.  Provide coverage for the Director when necessary and appropriate

·         Lead the IPC (Insurance Plan Committee) meetings to ensure that new contracts and relationships with payors are set up within Epic payor/plan master files ( INIs) to best support revenue cycle performance

·         Lead the monthly Payor Bulletin Review meetings and associated reporting to ensure that changes in payor rules related to revenue cycle are incorporated into the PRMO’s policies, procedures, and workflows in a timely, comprehensive, and accurate manner

·         Act as the primary li aison between PRMO departments and payors to effectively address and resolve strategic and operational issues that impact revenue cycle performance

·         Develop and maintain relationships with the relevant provider representatives, medical directors, and associated leadership for major payors that have contractual relationships with Duke Health

·         Identify opportunities for improving performance in revenue cycle operations through continuous engagement with payers and the analysis of data to identify adverse trends and/or operational underperformance

·         Work closely with DUHS and DHIP contracting management to ensure that new contracts are effectively implemented, in-services are completed promptly and offered to revenue cycle operations annually if needed, and share feedback provided from PRMO operational areas to assist with renegotiations

·         Represent the PRMO and Payer Relations at North Carolina Hospital Association, the North Carolina Medical Society, and the Four Schools Group, functions to maintain awareness of operational and legislative issues that may impact the PRMO’s revenue cycle operation

·          Ensure that the Payer Relations team is hosting monthly JOC meetings with payers, distributing weekly updates and monthly newsletters, and staying abreast of any operational changes within the payer community that would adversely impact revenue cycle operations

·          Develop and produce regular reports that summarize the status and performance related to payor bulletin review, IPC activity, overall revenue cycle performance (Report Card), and operational/s strategic issues raised by PRMO Departments related to payor relationships and revenue cycle performance

Staff Management (10%)

·         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 (analysts/supervisors)

·         Provide job-specific training and coaching 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 develop effective action plans for underperforming staff

·         Assist with the development of job-specific training programs for all staff within the team

·         Identify and implement programs to develop direct reports as well as associated staff for ongoing career development

·         Hold weekly team meetings to review performance, share new policies and procedures, and keep employees informed about relevant organizational updates/EPIC upgrade impacts

·         Identify and implement opportunities for improvement of staff morale

·          Ensure compliance with all PRMO and DUHS personnel policies

·         Engage in rounding with all staff frequently, documenting concerns and suggestions with follow-through where applicable

Policy & Procedure and Internal Controls (5%)

·         Develop and maintain documentation summarizing workflow processes and operating policy & procedure for all functions relegated to Self-Pay

·         Document and review changes to all operational processes with the departmental director before implementation.

·         Develop internal controls for all operational processes, ensuring the timely completion of internal control processes by staff, supervisor, and manager on an assigned periodic basis

·         Document and sign attestation to support the timely completion and oversight of all internal control functions every month

Managerial Duties (5%)

·         Prepare and submit an annual budget for approval alongside the department al director

·         Review actual vs. budgeted variances every month and provide a summary explanation to the departmental director

·         Identify negative budget variances and provide an explanation/effective game plan for addressing deficiencies

·         Identify opportunities to reduce or minimize personnel and non-personnel expenses

·         Respond to inquiries from PRMO and DUHS leadership, peers, and staff in a timely, accurate, and comprehensive manner (within 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 other managers or departmental directors in their/absence

·         Provide coverage for the Supervisor in their/absence

·         Other duties as assigned

Technical Expertise (10%)

·         Develop and maintain a working and effective knowledge of all functions performed by the team

·         Develop and maintain a working knowledge of relevant payor billing requirements and reimbursement regulations

·         Develop and maintain a working knowledge of all core systems (Epic) and ancillary systems (Hyland, RevSpring, DCM, Excel database/BOX, SharePoint, other applicable vendor applications) utilized within the department

·         Develop and maintain  a complete understanding of all operational policies and procedures relevant to the Self-Pay and Payer Relations teams

·          Develop and maintain working and proficient knowledge of personal computer software required for fulfilling management responsibilities, including Adobe, Excel, Word, Access database, Visio flowchart, PowerPoint, and IForms/SuccessFactors

Minimum Qualifications

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic on, national origin, race, religion, sex (including pregnancy and pregnancy-related conditions), sexual orientation, or military status.

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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 andDuke University Healt h System may include essential job functions thatrequire specific physic al and/or mental abilities. Additionalinformation and provision for requ ests for reasonable accommodation willbe provided by each hiring departm ent.

Education

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

Experience

Work req uires 5 years of experience in business or other applicableexperience. A master's degree in a related field, such as business orhealth adminis tration, may be substituted for experience on a 1:1 basis.

Degrees, Licenses, Certifications

Certifications in patient access or patient accounting preferred.

Duke is an 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 (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends onthe 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 essential job 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.