Patient Account Analyst - Payor Relations - Remote

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.

 

REMOTE POSITION: Monday - Friday

 

General Description of the Job Class:

The Patient Account Analyst is responsible for payer and external relations across the entire revenue cycle for hospital and professional services. The analyst will work collaboratively with all payers (governmental and non-governmental) to facilitate the dissemination of payer policies and procedures that impact payment, as well as internal departments, serving as a liaison between the health system and payers to  resolve complicated issues. The analyst will also work collaboratively with the denial management team analyzing third-party denial trends for hospital and professional services, researching root causes of claim denials, and working with PRMO Senior Leadership and Operational Management to reduce denial volumes to improve revenue cycle performance by enhancing revenue and reducing costs.

 

Duties and Responsibilities: 60%

• Develop and maintain strong working relationships with DUHS and Private Diagnostic Clinic large contracted payers (now inclusive of DHIP).
• Engage payers when necessary to reach resolution on unpaid accounts.
• Work closely with Duke entities contacting management to ensure that new contracts are effectively implemented and share feedback provided from PRMO operational areas to assist with renegotiations.
• Assist with managing the relationship with all applicable onsite, remote, and hybrid operational areas.
• Maintain, update and distribute the contract matrix on a monthly basis.
• Work closely with the North Carolina Hospital Association and keep abreast of operational and legislative issues that may impact the organization
• Conduct and attend payer in-service meeting primary payers on a quarterly basis. Provide education and feedback to clinic leadership as necessary.
• Review payer websites and ensure that issues which impact operations are tracked and assigned in the bulletin review database or any other solution that would facilitate information dissemination.
• Compile, develop and distribute the monthly payer newsletter to highlight operational changes.
• Represent DUHS and PDC by attending Four Schools, JOC, IMAC and other meetings as appropriate.
• Assist with the development of a patient facing education strategy.

 

 

 

30%

• Work collaboratively with the denial management team to understand the weekly and monthly denial reports across all systems that summarize denial performance and trends, with breakdowns by entity, payer, and rejection-type.
• Coordinate and conduct detailed research to identify root causes of denials, including a review of individual accounts/invoices on the billing systems, review of payer reimbursement documentation and on-line information, and discussion with operational billing & collection management and staff.
• Identify process improvements to reduce denial volumes, including staff education/training, operational workflow modifications, system enhancements/edits, and payer policy changes, and works with contract management team, PRMO management, and staff to implement improvements.
• Act as a technical resource to PRMO operational management and staff on the appropriate interpretation of rejection/denial codes and actions required for the effective resolution and follow up of those codes.

 

10%

• Communicate directly with third-party payers about operational issues (i.e., user, system, and payer) related to rejection/denials codes.
• Organize and lead committee meetings across DUHS, PRMO and PDC as it relates to denials, accounts receivable and or financial data operation improvements. Examples of committee involvement include Margin Management, Denial Steering Committee, High Dollar Review Committee, Registration Denial Sub-Committee, etc.
• Other duties as assigned.

 

Required Qualifications at the Level:

Bachelor’s degree in business, healthcare administration, accounting, finance or a related field is   required.

 

Experience and Skills:

Four years of experience in healthcare accounts receivable, financ