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 Description of the Job Class:

 

Please contribute to the achievement of the DUHS mission through the development and leadership of performance improvement activities in the operational and/or clinical arenas. 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 claims functions and overall management of the provider enrollment processes associated with enrolling applicable Health Systems and Physicians for all clients.  Oversee and coordinate Provid er Enrollment professional and hospital insurance collections and accounts receivable to maximize reimbursement, achieve A/R aging targets, minimize avoidable/controllable write-offs, and accomplish results as cost-effectively as possible.

 

Duties and Responsibilities of this Level:

 

A/R Management

 

• < li>Drive independent revenue cycle operational decisions to resolve complex issues impacting collections, patients, and providers. < /li>
• Prepare a weekly report summarizing inventory statistics, staff productivity and collections 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 Analyst to monitor denial rate trends, and identify & implement opportunities to reduce post-billing denial rates
• 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 preventable 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 to identify unworked accounts
• Define criteria and set up insurance work files/work sts to ensure the timely and comprehensive collection of all accounts receivable
• Assign staff to all insurance work files/work sts to ensure appropriate and equitable resource allocation and prioritization of outstanding workload
• Review daily/weekly/ monthly system reports summarizing inventory and staff performance to identify outstanding issues, including:
• Inventory reports
• Provider Enrollment status reports
• Issue log maintenance
• Prepare operational status updates on High Balance accounts for the weekly management meeting
• Prepare a monthly summary of accounts receivable by provider/payor for director review, with an explanation for changes in performance and specific plans to address deficiencies
• Research operational and system issues identified by staff, and develop/ implement solutions for performance improvement

 

 

Staff Management

 

• Oversee supervisor’s efforts in posting, recruiting, and hiring new employees
• Oversee supervisor’s efforts to provide job-specific training to new and existing employees
• Oversee supervisor’s mid-year and year-end performance evaluations of employees