Patient Account Analyst - Pre-Service Verification - 100% 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: 
•    Drive analysis, issue identification, and recommendations of opportunities to achieve balanced scorecard objectives related to verification of eligibility/coverage, authorization, and medical necessity.
•    Independently review revenue cycle performance data at a macro and micro level to identify outlier (problem/deficiency) results, pull detailed data to research the underlying issues.
•    Partner with management to formulate and implement operational/system solutions to drive results.
•    Primarily support real-time eligibility, payor/plan mapping, eligibility vendor solutions, projects and analysis related to strategic priorities for PreService Verification.

.

Duties and Responsibilities of this Level:

Data Analysis & Research – 70%
•    Proactively monitor and report system and department performance related to all payor eligibility, benefits, registration denials, and write-offs for Duke Health. 
•    Develop and produce report requests to support advanced research to understand underlying issues impacting system/user performance. 
•    Complete detailed analysis of accounts and summarize findings on a monthly basis. 
•    Perform root-cause analysis to isolate system, user, and/or payor related opportunities.
•    Summarize results and produce reporting that effectively outlines operational, system, and payor trends for PreService Verification management.
•    Organize and lead department workgroup meetings across various Revenue Cycle departments to share data/trends of eligibility responses, denials, and write-offs.
•    Analytical projects as assigned by management.

Formulate Recommendations & Implement Solutions – 20%
•    Use data analysis to identify opportunities to modify system functionality, operational workflows, or staff education to improve performance and results.
•    Utilize assistance of department staff, and leadership to confirm operational workflows and areas for improvement. 
•    Collaborate with PreService Verification, Service Access, Billing/Collections, Maestro Care teams, and Business Process Consultants on developing system recommendations.
•    Work with department management and health system stakeholders to plan and implement recommendations, and conduct follow up to ensure that implemented solutions are producing desired results.

 

Enhance Performance Reporting – 10%
•    Develop and enhance KPI and analytical performance reporting for the department, with a focus on trends by payor, denial, write-off, and denial/appeal resolution rates.

 

Required Qualifications at this Level:
Education:

    Work requires a Bachelor’s degree in Business, Accounting, Finance or a related field.  

Experience:
    Work requires four years of experience in healthcare accounts receivable, insurance billing, or a field directly related to specialized area of assignment.

Degrees, Licensure, and/or Certification:

    N/A

Knowledge, Skills, and Abilities:

    Knowledge of:

• Healthcare insurance and benefit information.
• Payor websites and integration of benefit information into Epic.
• Excel and other related software applications supporting data analysis.

 

Ability to:

• Proactively investigate and analyze information and provide solutions.
• Identify and communicate trends and impacts.
• Communicate effectively, both orally and written, with various levels of leadership (staff, management, senior management). 
• Examine workflows, formulate recommendations, and assist in creating operational policies/procedures. 
• Foster a positive work environment.
• Maintain strict confidentiality of patient medical and financial records, in compliance with federal and state patient privacy legislation.
• Follow established departmental policies, procedures, and objectives.

 

Systems:

• Epic

 

Duke is an Affirmative Action/Equal Opportunity Employ