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.
General Description of the Job Class:
Extract, prepare and analyze complex data, accounts and/or financial reports.
Review, analyze, trend, present and advise leadership regarding conclusions and recommendations.
Facilitate/implement resolutions focused on denial reduction initiatives
Serve as subject matter expert resource for covered areas
Duties and Responsibilities of this Level:
Conduct detailed analysis and research to identify denial/payor trends, including a review of account specifics to support/validate findings and/or provide recourse for denied accounts/avoidable adjustments.
Provide detailed review and recommendations for reduction in AR aging, Avoidable write offs, denial AR and high dollar AR.
Prepare/present written reports/presentations and analyses for leadership, highlighting trends and providing appropriate recommendations, solutions, and/or conclusions.
Serve as a subject matter expert resource to leadership in the decision-making process surrounding denial prevention strategies. Plays an integral role in implementing and managing change related to this area of expertise.
Serve as liaison to entity management and staff, documenting reports and analyses as well as discussing results, trends and recommendations with various stakeholders.
Act as a technical resource to operational management and staff on the appropriate interpretation of denial/financial data. Coordinate with and mentor staff regarding accounts receivable and financial systems, analyses, reports and policies/procedures.
Continue review of weekly invoice analysis, to document, identify and implement opportunities for increased upstream logic to prevent, or education/logic correction to totally eliminate aging, denials or avoidable write offs.
Continue weekly production of clear analysis facts and documentation; alert situations and descriptions related to aging patterns and avoidable concerns and invoice review results. This includes meeting weekly and monthly reporting deadlines for AR summaries.
Collaborate closely with other analysts in the department as well as additional departmental resources for further identification and documentation of opportunities to reduce aging AR and improve overall workflow processes.
Focus on expansion of knowledge base around Excel, documentation analysis, formal PowerPoint presentation optimization, dashboard review, and Epic reporting mechanisms (SlicerDicer).
Continue to enhance performance and clear communication of presentation of material to leadership in monthly meetings and in email request. Specifically, AR summaries for monthly Department RIC and PDC department presentations.
Evaluate opportunities to implement claim edits where applicable to reduce downstream, back-end denials and improve health system A/R turnaround time as a result.
Maintain organization of ongoing trending and analysis via a report repository in Box/shared drive.
Identify process improvement opportunities to include staff education/training, operational workflow modifications, system enhancements and external payer policy changes as well as working with and engaging appropriate personnel to implement and test change processes.
Maintain and update Issue Logs related to identified denial analysis trends and work with Payer Relations to establish coordinated resolutions thereof.
Organize and lead committee meetings across our entity as it relates to A/R and denial mgmt.
Develop and maintain a working knowledge of all functions performed by the PB&C department.
Develop and maintain a working knowledge of relevant payer billing requirements and reimbursement regulations.
Develop and maintain a working knowledge of all Maestro Care and ancillary systems utilized by the PB&C department.
Develop and maintain a complete understanding of all operational policies and procedures relevant to the department.
Develop and maintain working and proficient knowledge of personal computer software required for fulfilling management responsibilities, including: EPIC, Excel, Microsoft Word, Power Point, etc.
Provide ad hoc reporting to Sr. Leadership as needed.
Contributes to a positive working environment and performs other duties as assigned/directed to enhance overall efforts for Duke Health and the PRMO.
Perform other related duties incidental to the work described herein.
Required Qualifications at this Level
Bachelor's degree in business, healthcare administration, accounting, finance or a related field is required.
Four years of experience in healthcare accounts receivable, financial management, accounting or a directly related field is required.
Degrees, Licensure, Certification/
Knowledge, Skills, and Abilities
Data analysis and reporting background, Revenue Cycle experience, Microsoft Office (Excel, Access, Word, PowerPoint) - Excel proficiency and some EPIC experience highly preferred. Excellent verbal and written communication skills.
Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
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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.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.