PRMO: , established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke PrimaryCare. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke's reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.

The Revenue Integrity-Revenue Manager serves as a liaison among PRMO, Operational Owners and Maestro Care Clinical/Billing analysts to assist in the design, development, maintenance, training and evaluation for assigned Maestro Care clinical and business systems to support the revenue cycle. This position will be primarily responsible for design/re-design of workflow, working with Maestro Care Build teams, testing, and validating of application functionality specifically related to charge capture/billing for both the Charge Description Master (CDM) and Revenue Integrity. This position will coordinate all revenue cycle issues that arise for areas impacted by external medical audit request and code changes; and must be very knowledgeable of DUHS/PRMO policies, procedures, and business operations.

Payor/Regulatory/Compliance Oversight 30%

• Maintain a working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist the health system in cash collection while accurately complying with billing guidelines
• Advises and collaborates with the DUHS Compliance Officer, Internal Audit, Regulatory Review and Analysis, legal counsel and outside consultants to analyze, review and assess identified billing, coding, charging and compliance issues
• Continuously reviews and updates regulations and maintains current knowledge base
• Interprets government regulations and affects related process changes throughout the system to ensure compliance with these regulations as they relate to the CDM
• Perform other related duties incidental to the work described herein

Revenue and Project Management 70%

• Manage revenue cycle-related inquiries and respond, research and resolve revenue cycle-related inquiries
• Specialize & manage revenue cycle functions and Epic Systems applications; resolving accounts in assigned Charge Router, Charge Review. Claim Edit, and Follow-Up WQs
• Monitor & manage from key performance indicators; utilizing standard reports and/or develop new reports to track revenue cycle performance Areas of focus will include denial rates, avoidable write-off, and full transaction write-offs; deleted charges. Will also perform ad hoc analyses as requested, eg, high-dollar drug reimbursement; service/program/code specific reimbursement; actual charge to budget charge variance
• Develop and manage action plans & timelines Perform root cause analysis and provide expert and creative solutions. Actions to be taken to achieve resolution. Assemble cross-functional team within PRMO (if applicable), Develop Revenue cycle-related project plan, maintain comprehensive issues lists with time lines and responsibilities clearly assigned, escalate issues through PRMO Senior Operational Leaders that require significant cross-departmental resources
• Work with revenue management, department, and PRMO operational managers to ensure newly implemented workflows and procedures support revenue cycle integrity

Minimum Qualifications

Bachelors degree required. Masters degree preferred.

Six years of experience in the healthcare industry is required.

BA, BBA, RN, CPC, RRA, or CPA, or higher

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Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.