Manager, Patient Revenue (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.

This position may have an opportunity to work remotely. All Duke University remote workers must reside in one of the following states or districts: Arizona; California; Florida; Georgia; Hawaii; Illinois; Maryland; Massachusetts; Montana; New Jersey; New York; North Carolina; Pennsylvania; South Carolina; Tennessee; Texas; Virginia or Washington, DC

 

General Description of the Job Class:

 

Contribute to the achievement of the DUHS mission through the development and leadership of performance improvement activities in the operational and/or clinical areas. Assure continual compliance with regulations and accreditation standards through monitoring activities and the design and implementation of strategies to enhance compliance. Responsible for billing and claim functions and overall AR management for the health systems and physicians.  Oversees and coordinates insurance collections and accounts receivable to maximize reimbursement, achieve A/R aging targets, minimize avoidable/controllable write-offs, and achieve results as cost-effectively as possible.

 

 

Duties and Responsibilities of this Level:

 

A/R Management (35%)

·         Drive independent revenue cycle operational decisions to resolve complex issues impacting collections, patients, and providers.

·         Prepare a weekly report summarizing inventory statistics, staff productivity, collection performance, and accounts receivable aging trends.

·          Identify deficiencies in staff performance and backlogs in inventory statistics promptly and take action to address outstanding issues.

·          Work with denials & AR analysts to monitor denial rate trends, aged AR inventory, and AR outliers and identify &

implement opportunities to reduce outstanding AR.

·         Review and approve write-off requests per policy.  Provide feedback to supervisor and staff if write-of requests are not in compliance with policy requirements.

• Review avoidable write-off trends and identify & implement opportunities to reduce avoidable write-offs.

·         Work with other PRMO management and DUHS leadership to improve collections, reduce accounts receivable, reduce denial rates, and reduce avoidable write-offs through issue identification, research, communication, and process improvement.

·         Pull reports to review aged outstanding insurance accounts receivable and take necessary action to address backlogs or identify unworked accounts.

·         Define criteria and set up insurance work files and work lists to ensure the timely and comprehensive collection of all accounts receivable.

·         Work with Clearinghouse to monitor rejection rate trends and identify & implement opportunities to reduce claim edit rejection rates and payer return rejection rates, or to increase claim edits to lessen backend billing denials and address them before claim filing.

·         Work with outsourcing vendors to monitor performance around billing and claim logic to improve overall performance and prevent backend billing denials, coding denials, or other AR concerns.

·         Assign staff to all insurance work files and work lists to ensure appropriate and equitable resource allocation and prioritization of outstanding workloads.

·         Review daily, weekly, and monthly system reports and Epic dashboards summarizing inventory and staff performance to identify outstanding AR issues.

·         Prepare operational status updates on high-balance accounts for weekly management meetings and reviews.

·          Prepare a monthly summary of accounts receivable by entity, division, or payer for senior manager and director review, with an explanation for changes in performance and specific plans to address deficiencies.

·         Research operational and system issues identified by collectors and develop/implement solutions for performance improvement.

 

Staff management (25%)

·         Oversee the supervisor’s efforts in posting, recruiting, and hiring new employees.

·         Oversee the supervisor’s efforts to provide job-specific training to new and existing