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.
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.
REMOTE POSITION: Monday - Friday
General Description of the Job Class
Coordinate, prepare and analyze complex accounts receivable and/or financial reports. Review and analyze trends, advising PRMO, DUHS and PDC leadership regarding conclusions and recommendations. Serve as expert resource for covered area.
Duties and Responsibilities of this Level
65% Service Now Review/Testing:
- Identify process improvements, including staff education/training, operational workflow modifications, system enhancements and external payer policy changes and work with Billing and Collection management to request and implement those improvements.
- Enter Service Now tickets for system changes related to billing and collections.
- Perform positive and negative testing of system changes to ensure appropriate updates are made and validate the process once the changes are moved to production.
- Collaborate with DHTS Maestro Care team to communicate operational needs, coordinate testing efforts, and ensure appropriate turn around on changes and resolution of tickets.
- Serve as an expert resource to leadership in decision-making process. Plays an integral role in implementing and managing change related to area of expertise.
- Become a subject matter expert related to system logic and functionality.
- Primary tester and liaison for system upgrade testing which includes performing parallel testing and providing feedback to leadership on issues found during testing.
- Initiate and implement system logic changes per review of payor bulletins and guidelines.
30% AR Review:
- Identify trends and opportunities for improvement for operational, payor, system and/or user issues.
- Monitor clean claim rates and reporting to identify trends associated with edits across operational systems.
- Escalate trends to management with recommendations for resolution with ideas/opportunities.
- Proactively monitor payor rules and regulations related to claims logic build and billing guidelines.
- Assist with facilitation of workgroup meetings including updating project log and validating testing within the system.
- Prepare written reports and analysis for PRMO, DUHS and PDC leadership highlighting trends and appropriate recommendations/conclusions.
- Maintain liaison with DUHS, PRMO and PDC management and staff, documenting reports and analysis and discussing results, trends and recommendations.
- Conduct detailed research to identify trends, including a review of specifics in the appropriate accounts receivable and/or financial systems.
- Act as a technical resource to operational management and staff on the appropriate interpretation of accounts receivable and/or financial data. Coordinate and mentor staff regarding accounts receivable and financial systems, analyses, reports and policies/procedures.
5% Other
- Organize and lead committee meetings across DUHS, PRMO and PDC as it relates to accounts receivable and or financial data operation improvements.
- Perform other related duties incidental to the work described herein.
Required Qualifications at this Level
Education:
Bachelor's Degree in business, healthcare administration, accounting, finance or a related field is required
Experience:
Minimum of four years of applicable experience.
Previous experience successfully managing complex projects involving multiple stakeholders with a consistent track record of delivering on time, or high quality results preferred.
A Master's degree in a related field can substitute two years of experience on a 1:1 basis.
Degrees, Licensure, and/or Certification:
Knowledge, Skills, and Abilities:
Data analysis and reporting Billing/Collections Insurance Claims Microsoft Office (Excel, Access, Word, Powerpoint) Good communication skills (verbal and written) are essential. Knowledge of Epic and IT related training/testing is essential.
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 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 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.