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REVENUE MANAGER
Duke University Health System
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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.
Job Description
Coordinate activities of staff responsible for charge capture, coding, charge entry, insurance follow-up, reimbursement analysis, or other PRMO functions for the 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 the assigned clinical area. Review and recommend changes/updates to the department's charge master(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 other outstanding 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 analyst /or other employees. Perform other related duties incidental to the work described herein.
The PRMO Revenue Manager serves as a li aison among PRMO, Operational Owners, and Maestro Care Clinical/Billing analysts to assist in the design,
Revenue Management Key Accountabilities
Duty Statements
Performance Standards
Revenue Management
Manage revenue cycle-related Must be inquiries Monitor & manage key performance indicators Must be able to perform data anal ysis Monitor & manage reimbursement changes Must be able to interpret policies Percent of Time30%
Revenue Cycle Leadership Key Accountabilities Performance Standards
Revenue Cycle Leadership Facilitate revenue cycle collaboration and strategic planning activities Coordination of activities is expected to be carried out out with minor supervision Coordinate and chair revenue-oriented workgroup activities and meetings Must be capable of setting priorities and working under pressure Manage communications a mong PRMO, hospitals, and physi cian practices Must be able to facilitate meetings of multi-disciplinary teams Arrange revenue cycle training activities Must be able to understand the basics of topics Percent of 30%
Project Management Key Accountabilities
Performance Standards
Project Management Manage and prioritize revenue and/or compliance requests Must be able to manage projects simultaneously Develop and manage action plans & timelines Must be able to organize and keep deadlines Identify and recruit appropriate resources Must be able to develop strong relationships Develop creative solutions Must be able to be process-oriented Percent of Time 30%
Epic Systems Advisory Key Accountabilities Duty Statements Performance Standards
Project Management
Epic Systems applications Must be able to investigate charges and claims information, and navigate information systems
Percentage of Time 10%
Specific Job Duties/Key Accountabilities
Revenue Management Duty Statements Details 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 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< span> accounts in the assigned Charge Router, Charge Review. Claim Edit, and Follow-Up WQs
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, full transaction write-offs, and deleted charges. Will also perform ad h oc analyses as requested, e.g., high-dollar drug reimbursement; service/program/code specific reimbursement; actual charge to budget
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. 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; cha nges in billing/claims requiremen ts; LCDs. Monitor payer regulations & coordinate strategies through Bulletin Review and other resources. Percent of Time 30%
Revenue Cycle Leadership Duty Statements Details Facilitate revenue Serve activities (reduce redundancies) and keep senior leadership informed Participate in routine meetings with CFOs, AVP, and Reimbursement Revenue 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 Coordinate and chair revenue-oriented workgroup activities and meeting Share operational changes to/from PRMO to the hospital and physician practice Develop or participate in focused collections, coding, and charge capture, Maestro Care applications. Facilitate discussions and strategies to address operational issues. Escalate issues as needed. Manage communications among PRMO, hospitals, and Managing communications between PRMO and Hospital Operational Owners 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. Arrange revenue cycle training activities Coordinate training for non-charge capture revenue cycle topics as needed Facilitate Revenue Manager training around work/skills career development topics (e.g, Report writing, Branding & Marketing, Communications, Project Management, Onboarding, Compliance/Regulation Interpretation, HL7 interfaces; how WQ logic works) Percent of Time 30% Project Management Duty Statements Details
Manage revenue and/or compliance requests. Manage request-based Revenue Enhancement and/or Compliance process improvement Projects (e. g., New, Modified, and Manage routine-based: Annual CP T Updates: coordinate, working with Health System Operations Managers in assigned applications: DUHS Revenue Management and PRMO CDM Team, Hospital. Finance, and PDC Revenue Managers, including an Annual review of charges and DEPs Investigate and manage revenue opportunities identified through reporting and analysis.
Develop and manage action plans & timelines. Perform root cause analysis and provide expert and creative solutions. Resolution Assemble a cross-functional team within PRMO (if applicable), develop a Revenue cycle-related project plan, maintain a comprehensive issues list 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, and PRMO operational managers 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: 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.
Work with PRMO/Maestro Care professional and/or technical billing teams to determine the need for/request updates to charge router logic, charge review logic/work queue definition, and claim logic. Immediately after go-live of new services, validate revenue cycle functions operating as expected: confirming accurate billing; monitoring specific patient examples for denials/payments. Notify other PRMO operational areas of the new service so they can determine
Example subjects: o Master File creation record creation/updates: billing provider record (SER), department Record o New charge code creation (as applicable) - assist department operational manager in determining if new charge codes o 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 linked chargeable; work with PRMO coding Staff to ensure awareness of new services/charge codes; Develop creative solutions Utilize knowledge in revenue cycle and system applications to investigate root causes of problems, and guide the process to fix Lead multi-disciplinary teams in brainstorming activities to develop sustainable solutions to emergent and long-standing problems. Percent of Time 30% Epic Systems Advisory Duty Statements Details Specialize & manage revenue cycle functions and Epic Systems applications Must be able to investigate charge and claim information, and navigate information systems
Percent of Time 30% Minimum Qualifications
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, proactively, and adapt appropriately to
Education
Bachelor's degree required. Master's degree preferred.
Experience
At least 6+ years of relevant Healthcare experience, preferably in Charge Integrity, is required. Strong leadership capabilities with demonstrated ability to lead, motivate, and collaborate effectively with Hospital leadership. Strong oral and written communication skills.
Degrees, Licensures, Certifications
Coding certification (e.g. CCS, CPC, RHIA, RHIT), HFMA CHFP (Certified Healthcare Professional), CRCR (Certified Revenue Cycle Representative) preferred
Minimum Qualifications
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetici nformation, national origin, race, religion, sex (including pregnancyand pregnan cy related conditions), sexual orientation or militarystatus.
Duke aspires to create a community built on collaboration,inno vation, creativity, and belonging. Our collective success depends onthe robust exchange of ideas-an exchange that is best when the richdiversity of our perspectives, backgrounds, and experiences flourishes.To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected , and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions: Certain jobs at Duke University andDuke University Healt h System may include essential job functions thatrequire specific physic al and/or mental abilities. Additionalinformation and provision for requ ests for reasonable accommodation willbe provided by each hiring departm ent.
EducationBachelor's degree required. Master's degree preferred.
ExperienceSix year s of experience in the healthcare industry is required. Degrees, Licensures, CertificationsBA, BBA, RN, CPC, RRA, or CPA, or high er
Duke is an 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 (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends onthe robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job 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.
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