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.

 

Outpatient Pre-Service Verification is an integral part of the revenue cycle, responsible for overseeing the verification of patient insurance eligibility, prior authorization, and medical necessity forp hysician and hospital outpatient services provided across Duke Health.

 

This position is responsible for the management of internal/external staff and processes supporting pre-service verification functions while modeling Duke’s values and demonstrating expected behaviors. The scope of prior authorization and medical necessity includes but is not limited to, oncology/non-oncology services, infusion, interventional radiology, orthopedics, pediatrics, and labs. The manager is also responsible for the oversight of technical systems supporting automated/real-time authorization(RTA) and medical necessity.

 

 

Operational Management 40%

• Drive independent revenue cycle operational decisions to resolve complex issues impacting authorizations, patients, and providers.
• Prepare weekly and monthly reports summarizing operational performance related to service volumes completed, outstanding inventory (work-in-progress), and outcomes of verification related to eligibility/authorization/medical necessity.
•  Identify deficiencies in staff performance and inventory backlogs promptly, and take action to address outstanding issues.
• Partner with Patient Account Analysts to monitor authorization and registration denial rates and write off trends to identify and implement opportunities to improve performance.
• Review and approve write-off requests per policy.
• Work proactively and collaboratively with other PRMO management and DUHS identification, research, communication, and process improvement.
• Define criteria and create operational workflows and system work queues to ensure timely and comprehensive verification of eligibility, authorization, and medical necessity for all outpatient visits/services.
• Monitor operational performance and assign/allocate staff to all system work queues to ensure appropriate and equitable resource allocation and prioritization of outstanding workload.
• Communicate with organizational customers/stakeholders to proactively identify and manage performance issues.

 

Technical Expertise 25%

 

• Develop and maintain a working and effective knowledge of all operational functions, policies, and procedures performed within the department, related to insurance payor requirements for verification of coverage/eligibility, authorization, and medical necessity.
• Develop and maintain a working knowle dge of the associated technical logic within the Epic system as well as bo lt-on systems supporting eligibility and automated authorizations.
• Develop and maintain work ing and proficient knowledge of personal computer software required for fulfilling management responsibilities, including:  Microsoft office (Outl ook, Excel, Word,PowerPoint, etc.), patient accounting systems, IT systems (Service Now Requests),and HR systems (payroll, I-forms,and API PTO).

 

 Staff Management 25%

• Post, recruit, and hire direct reports, and provide orientation to new hires.
• Provide job-specific training to existing direct reports, and ensure that appropriate training is available and provided to staff within the department.
• Ensure that monthly Overall Effectiveness Rating (OER) scores (productivity and quality) are determined for each employee, and feedback is