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.

General job description:

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 for physician 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 a demonstrating expected behaviors. The scope of prior authorization and medical necessity includes, but is not limited to, radiology, cardiology/ cath, neurology, pediatrics, multi-specialty services, PCP referral requirements, and veteran administration. The manager is also responsible for the oversight of technical systems supporting real-time eligibility (RTE )and automated/real-time authorization (RTA).

·         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 knowledge of the associated technical logic within the Epicsystem as well as bolt-on systems supporting eligibility and automated authorizations.

·         Develop and maintain working and proficient knowledge of personal computer software required f or fulfilling management responsibilities, including:  Microsoft Offic e (Outlook, Excel, Word, PowerPoint, etc.), patient accounting systems, IT systems (Service Now Requests), and HR systems (payroll, I-forms, an d 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, a 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, 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.

·       Hold regular team meetings to review performance, share new policy 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 Internal Controls 5%

·          Develop and maintain documentation summarizing workflow processes and operating policy& procedure for all functions handled by the team.

·         Review changes to all operational processes with the department directly or 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 an assigned periodic basis.

Other Man agerial Duties 5%

·         Prepare and submit for approval an annual budget for the department.

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

·     Identify opportunities to reduce or minimize personnel and non-personnel costs.

·         Respond to inquiries from PRMO and DUHS leadership, peers, a nd 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 fina ncialdata and patient medical data consistent with HIPAA standards.</s pan>

·        Provide coverage for peer managers in their/absence.

·          Other duties as assigned.

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 thecommunity feel se cure and welcome, that the contributions of allindividuals are respected , and that all voices are heard. All members ofour community have a resp onsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Healt h System may include essential job functions that require 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 requires 5 years of experience in business or other applicable experience. 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, Licensures, 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.