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

 

*** MUST RESIDE IN NORTH CAROLINA***

 

General Description of the Job Class:

 

• Perform quality assurance reviews of accounts which impact revenue cycle activities as well as adherence to compliance and regulatory requirements
• Compile, analyze and report on QA performance of departmental operating units, noting trends and making recommendations or conclusions which are in alignment with the financial performance of the Health System.
• Review financial reporting and trends impacting reimbursements/cash projections (denials/write offs/performance dashboards); coordinate projects and quality assurance reviews based on trends; provide workflow recommendations for discovered deficiencies to improve reimbursement/cash projections
• Track financial performance related to changes in workflow and/or recommendations
• Provide front end registration support to outpatient clinics as needed.

 

Duties and Responsibilities of this Level:

 

70%

• Investigate and resolve underpayment accounts on a daily basis
• Analyze contracts against payer explanation of benefits to determine opportunities for additional payments
• Engage with contracted payers to resolve accounts in a timely manner
• Support and engage in monthly payer meetings/calls for any escalated revenue situations
• Analyze and provide feedback for departmental specific reports
• Utilizes account receivable knowledge and resources to ensure accurate and compliant billing and to recognize and resolve inconsistencies with underpayment workflow
• Manage appropriate systems for accounts receivable and/or financial reporting and prepare written reports/summaries for leadership documenting trends and appropriate recommendations/conclusions including process improvements and optimization opportunities
• Assist management in forecasting by providing historical information. Work with departmental Directors, Managers and appropriate personnel to ensure budgetary compliance< /p>
• Trend and report on departmental performance indicators and goals. Ensure departmental goals are satisfied
• Make recommendations to improve financial systems; perform in house audits of operating units; analyze deficiencies and report to manager/director.
• Trend and assist in resolving No Surprise Act account reviews

 

  

20%

• Responsible for any system upgrade testing/report outs associated with WQ assignment/under payments.
• Assist with documentation support for any job aid updates/optimizations
• Develop and provide job-specific training to new and existing employees wi thin department.
• • Assist in developing and defining short and long term departmental specific goals and objectives
  • Creation and development of work assignments including training assistance for new hires if needed
  • Maintain professional relationship with internal and external agencies and professional organizations concerning operations<