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 Primary Care. 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 Dukeâ€™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.
Revenue Manager Neuro/Psych (100% Remote M-F)
This position may have an opportunity to work remotely. All Duke University remote workers must reside in one of the following states or districts: Arizona; California; Florida; Georgia; Hawaii; Illinois; Maryland; Massachusetts; Montana; New Jersey; New York; North Carolina; Pennsylvania; South Carolina; Tennessee; Texas; Virginia or Washington, DC
Coordinate activities of staff responsible for charge capture, coding, charge entry, insurance follow-up, reimbursement analysis, or other PRMO functions for assigned clinical area Monitor performance for staff responsible for appointment scheduling, registration, clinic check-in, and clinic collections. Develop and prepare/utilize reports to track financial and operational performance across the entire spectrum of the revenue cycle for assigned clinical areas. Review and recommend changes /updates to the department's chargemaster(s) to maintain fees at levels that maximize reimbursement. Review and recommend changes to the department's charge capture documents to facilitate accurate and comprehensive billing in compliance with annual CPT-4 and ICD-9 updates. Identify revenue cycle problems, research/analyze data to resolve issues, identify and select alternatives to address outstanding issues, and implement improvement solutions. Work with financial analysts, physicians, and administrative leadership to educate and train providers and staff about coding and other outstanding revenue cycle issues.
Act as a liaison to management and staff in the designated clinical area, PDC, PRMO, DUHS hospitals, and third-party payers on revenue cycle activities for assigned areas. Continuously research, monitor, provide education, and implement payer regulations and guidelines related to revenue management activities of the assigned clinical area. Coordinate revenue management orientation and educational activities of clinical personnel including providers and staff about coding and understanding revenue cycle issues. Develop and utilize management models to monitor productivity and quality of staff performance. Develop and manage the budget for the staff and activities that are directly managed. Train, direct, and coordinate activities of assigned financial analysts/ or other employees. Perform other related duties incidental to the work described herein.
The revenue manager coordinates activities performed by the staff responsible for charge capture, coding, charge entry, insurance follow-up, reimbursement analysis, or other PRMO functions within the assigned clinical area. Monitor the performance of staff responsible for appointment scheduling, registration, clinic check-in, and clinic collections. Develop and prepare/utilize reports to track financial and operational performance across the entire spectrum of the revenue cycle for assigned clinical areas. Review and recommend changes/updates to the department's chargemaster (s) to maintain fees at levels that maximize reimbursement. Review and recommend changes department's charge capture documents to facilitate accurate and comprehensive billing in compliance with annual CPT/HCPCS and ICD-10 updates. Identify revenue cycle problems, research/analyze data to resolve issues, identify and select alternatives to address outstanding issues, and implement improvement solutions. Work with financial analysts, physicians, and administrative leadership to educate and train providers and staff about coding and other outstanding revenue cycle issues. Act as a liaison to management and staff in the designated clinical area, Patient Revenue Management Organization (PRMO), Duke University Health System (DUHS), Duke Health Integrated Practice, and third-party payers on revenue cycle activities for assigned areas.
Continuously research, monitor, provide education, and implement payer regulations and guidelines related to revenue management activities of the assigned clinical area. Coordinate revenue management orientation and educational activities of clinical personnel including providers and staff about coding and other outstanding revenue cycle issues. Develop and utilize management models to monitor productivity and quality of staff performance. Train, direct, and coordinate activities of assigned financial analysts/or other employees. Perform other related duties incidental to the work described herein.
The PRMO 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 of assigned MaestroCare clinical and business systems to support the revenue cycle. This position will be primarily responsible for the design/re-design of workflow, working with Maestro Care Build teams, testing, and validating application functionality specifically related to charge capture/billing. This position will coordinate all revenue cycle issues that arise for their application area and must be very knowledgeable of DUHS/PR MO policies, procedures, and business operations.
Revenue Management - 40% of Time
KeyAccountabilities -Revenue Management
· Duty Statement:
o Manage revenue cycle-related inquiries
o Monitor &am p; manage from key performance indicators
o Monitor & manage reimbursement changes
· Performance Standards:
o Must be able to communicate effectively, provide timely responses, identify resources to resolve inquiries
o Must be able to perform data analysis
§ Must be able to interpret policies
Revenue Cycle Leadership - 30% of Time
KeyAccountabilities - Revenue Cycle Leadership
· Du ty Statements
o Facilitate revenue cycle collaboration and strategic planning activities
o Coordinate and chair revenue-oriented workgroup activities and meeting
o Manage communications among PRMO, hospitals, and physician practices
o Arrange revenue cycle training activities
· Performance Standards
o Coordination of activities is expected to be carried out with minor supervision
o Must be capable of setting priorities and working under pressure
o Must be able to facilitate meetings of multi-disciplinary teams
o Must be able to understand the basics of topics
Project Management- 20% of Time
Key Accountabilities - ProjectManagement
· Duty Statements
o Manage and prioritize revenue and/or compliance requests
o Develop and manage action plans & timelines
o Identify and recruit appropriate resources
o Develop creative solutions
· Performance Standards
o Must be able to manage projects simultaneously
o Must be able to organize and keep deadlines
o Must be able to develop strong relationships
o Must be able to process-oriented
Epic Systems Advisory - 10% of Time
Key Accountabilities - ProjectManagement
· Duty Statements
o Specialize & manage revenue cycle functions and Epic Systems applications
· Performance Standards
o Must be able to investigate charge and claim information, and navigate information systems
Specific JobDuti es/Key Accountabilities
Revenue Management - 40% of Time
1) Manage revenue cycle-related inquiries
Serve as Point Person/Service Line Resource(Liaison)
Respond, research, and resolve revenue-cycle-related inquiries about assigned MC applications
Manage assigned Service Now tickets
2) Specialize & manage revenue cycle functions and Epic Systems applications
Serve as EPIC System knowledge source for charge capture functions (charge capture, reconciliation, and corrections for procedures, medications, and supplies as appropriate) with specific applications(interface b/w Maestro & PRMO claims processing needs)
Provide training on charge capture, reconciliation, and correction as needed
Resolve accounts in assigned Charge Router, Charge Review. Claim Edit, and Follow-Up WQs
3) Monitor & manage key performance indicators
Utilize standard reports and/or develop new reports to track revenue cycle performance for assigned applications clinical services. Areas of focus will include denial rates, avoidable write-offs, and full transaction write-offs; deleted charges. Will also perform ad hoc analyses as requested, e.g., high-dollar drug reimbursement; service/program/code specific reimbursement; actual charge to budget charge variance review key metrics from scheduling to billing& collections, in collaboration with PRMO Managers
Identify issues through ongoing monitoring of departmental metrics and/or through routine meetings with key operational managers within PRMO to facilitate communication.
4) Monitor & manage reimbursement changes
Continuously research and monitor payer regulations; provide education to operational areas as applicable; coordinate with PDC revenue managers to educate physicians; facilitate implementation of modifications to revenue cycle functions to meet changing payer requirements/regulations, e.g., new authorization requirements; changes in billing/claims requirements; LCDs.
Moni tor payer regulations & coordinate strategies through Bulletin Review and other resources
Revenue Cycle Leadership- 30% of Time
1) Facilitate revenue cycle collaboration and strategic planning activities
Serve as Duke Revenue Cycle Management ∫egration lead for assigned areas to coordinate activities (reduce redundancies) and keep senior leadership informed
Participate in routine meetings with CFOs, AVP, and ReimbursementRevenue Accounting to provide updates on current revenue cycle issues/priorities
Providing service line-specific strategic planning/priorities to PRMO leadership through Revenue Manager Councils/Operations Meetings
2) Coordinate and chair revenue-oriented workgroup activities and meeting
Share operational changes to/from PRMO to hospital and physician practice
Develop or participate in focused workgroups to address topics such as registration, billing & collections, coding, and charge capture, Maestro Care applications
Facilitate discussions and strategies to address operational issues
Escalate issues as needed
3) Manage communications among PRMO, hospitals, and physician practices
Managing communications between PRMO and hospital OperationalOwners and Providers
Organize and lead workgroups to routinely meet with Operations regarding PRMO function, issues, trends, etc., affecting revenue cycle performance
Actively participate in service line-specific strategic planning around revenue cycle prioritization and planning
4) Arrange revenue cycle training activities
Coordinate training for non-charge capture revenue cycle topics as needed
Facilitate Re veRevenueger training around work/skills or career development topics (e .g.e.g.port writing, Branding &Marketing, Communications, Project Management, Onboarding, Compliance/Regulation Interpretation, HL7 interface s; how WQ logic works)
Project Management - 20% of Time
1) Manage revenue and/or compliance requests
Manage request-based Revenue Enhancement and/or compliance process improvement projects (e.g., New, Modified, and Discontinued Services Request Management, including new services and locations
Manage routine-based: Annual CPT Updates: coordinate, working with Health System Operations Managers in assigned applications: DUHS Revenue Management and PRMO CD M Team, Hospital Finance, and PDC RevenueManagers; including Annual review of charges and DEPs
Investigate and manage revenue opportunities identified through reporting and analysis
2) Develop and manage action plans &timelines
Perform root cause analysis and provide expert and creative solutions. Actions to be taken to achieve resolution include:
Assemble cross-functional team within PRMO (if applicable), Develop Re venue cycle-related project plan, maintain comprehensive issues lists with timelines and responsibilities assigned, and escalate issues through PRMO Senior Operational Leaders that require significant cross-departmental resources.
Assist in the development of re-engineered best practice workflow processes and identify system optimization that improves revenue cycle performance
Work with revenue management, department, andPRMO operational managers to ensure newly implemented workflows and procedures support revenue cycle integrity
Coordinate all Maestro Care revenue-cycle-related system set-up/modifications necessary to bring up new services. Manager to completion. Specific functions include but are not limited to:
3) Identify and recruit appropriate resources
Work with Maestro Care trainers and administrative leadership (operations, medical directors, etc.) to educate and train providers and staff about new services; specifically charge capture and their role related to the revenue cycle
Work with PRMO/Maestro care professional and/or technical billing teams to determine the need for/request updates to charge route logic; charge review logic/work queue definition; claim logic
Immediately after the go-live of new services, validate revenue cycle functions operating as expected: confirming accurate billing; monitoring specific patient examples for denials/payments.
Noti Notifyr PRMO operational areas of new service so they can determine what, if any changes are required, e.g., provider enrollment access/ pre-registration
Master File creation on record creation/updates: billing provider record (SER), department Rec ord (DEP) bill area record (BIL), and charge codes (EAP)
New charge code creation (as applicable) -assist department operational manager in determining if new charges codes are needed (department manager submits request)
Charge capture methodology validation/updates -specific tasks dependent on charge capture method employed: update charging preference lists; work with Maestro Care application owner to update flowsheets; create/update orderable; confirm linke d chargeable; work with PRMOcoding Staff to ensure awareness of new services/charge codes;
4) Develop creative solutions
Utilize knowledge in revenue cycle and system applications to investigate root causes of problems, and guide processes to fix issues
Lead multi-disciplinary teams in brainstorming activities to develop sustainable solutions to emergent and long-standing problems
Epic Systems Advisory- 10% of Time
1) Specialize & manage revenue cycle functions and Epic Systems applications
Must be able to investigate charge and claim information, and navigate information systems
Ideal candidates will be able to balance the above tasks while maintaining flexible, friendly interaction with Operational and Hospital Leadership. The ability to work independently, and proactively, and adapt appropriately to changing priorities is a must.
Six years of experience in the healthcare industry is required.
Degrees, Licensures, Certifications
BA, BBA, RN, CPC, RRA, or CPor higher
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