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:
Contribute to the achievement of the DUHS mission through the development and leadership of performance improvement activities in the operational and/or clinical arenas. Assure continualcompliance withr egulations and accreditation standards through monitoring activities and the design and implementation of strategies to enhance compliance. Responsible for billing and claims functions and overall managementof the provider enrollment processes associated with enrolling applicable Health Systems and Physicians for all clients. Oversees and coordinates insurance collections and accounts receivable for the purpose of maximizing reimbursement, achieving A/R aging targets,minimizing avoidable/co ntrollable write-offs, and accomplishing results ascost-effectively as possible.
Dutiesand Responsibilities of this Level:
Drive independent revenue cycle operational decisions to resolve complex issues impacting collections, patients and providers.
Prepare weekly report summarizing inventory statistics, staff productivity and collections performance, and accounts receivable aging trends
Identify deficiencies in staff performance and backlogs ininventory statistics in a timely manner, and take actionto address outstanding issues
Work with Denials Analyst to monitor denial rate trends, and identify & implement opportunities to reduce post-billing denial rates
Review and approve write-off requests per policy. Provide feed back to supervisor and staff if write-off requests are not in compliance with policy requirements
Review avoidable write-off trends, and identify & implement opportunities to reduce avoid able write-offs.
Work with other PRMO manage ment and DUHS leadership to improve collections, reduce accounts receivable, reduce denial rates, and reduce avoidable write-offs through issue identification, research, communication, and process improvement
Pull reports to review aged outstanding insurance accounts receivable, and take necessary action to address backlogs or to identify unworked accounts
Define criteria and set up for insurance workfiles/worklists to ensure timely and comprehensive collection of all accounts receivable
Assign staff to all insurance workfiles/worklists to ensure appropriate and equitable resource allocation and prioritization to outstanding workload
Review daily/weekly/monthly system reports summarizing inventory and staff performance to identify outstanding issues,including:
Activity Code Utilization reports
Provider Enroll ment status reports
Workgroup issue log main tenance
Prepare operational status updates on High Balance accounts for weekly management meeting and review
Prepare a monthly summary of accounts receivable by entity/division/payorfor senior manager and director review,with explanation for changes in performance and specific plans to address deficiencie s
Research operational and system issues identified by collectors,and develop/implement solutions for performance im provement
Oversee supervisor's efforts in posting, recruiting, and hiring new employees
Oversee supervisor's efforts to provide job-specific training to new and existing employees
Oversee supervisor's mid-year and year-end performance evaluationsof employees
Post, recruit, and hire direct reports (supervisors)
Provide job-specific training to new and existing direct reports
Conduct mid-year and year-end performance evaluations and provide feedback to direct reports
Review results of monthly employee quality reviews, and take action on under performing staff results
Ensure that all provider enrollment processes are completed inanaccurate, timely manner and that credentials are up to date
Oversee the claims billing and provider enrollment workgroupfunction s to ensure appropriate logic in place for revenue success
Oversee all revalidations and reverifications related toe nrollment to ensure timely completion
Support the supervisor in oversight of completing enrollment packets for providers and groups in an accurate and timely manner
Assist with the development of job specific training programs for all staff within team
Identify and implement programs to develop direct reports and associated staff forcareer development
Hold monthly team meetings to review team performance, share new policy and procedures, and keep employees informed about PRMO updates
Identify and implement opportunities for improvement of staffmorale
Ensure compliance with all PRMO and DUHS personnel policies
Policy & Procedure and Internal Controls
Develop and maintain documentation summarizing workflow processe sand operating policy & procedure for all functions handled by team.
Document and review changes to all operational processes with department senior manager and director prior to implementation.
Develop internal controls for all operational processes, and ensure the timely completion of internal control processes by staff,supervisor, and manager on assigned periodic basis
Prepare and submit for approval an annual budget for the team
Review actual vs. budgeted variances on a monthly basis, and provide summary of explanation to senior manager and director
Identify negative budget variances, and provide explanation and game plan for addressing deficiencies
Identify opportunities to reduce or minimize personnel and non-personnel costs
Respond to inquiries from PRMO and DUHS leadership, peers, andstaff in a timely, accurate, and comprehensive manner (ie: 24-48 hours,depending on circumstances)
Adhere to all PRMO and DUHS revenue cycle policies and regulations
Respect and maintain confidentiality regarding patient/ guarantor financial data and patient medical data consistent with HIPAA standards
Validate and reassess productivity standards through observations,documenting and sharing for management review and recommendresolution/feedback.
Provide coverage for Director in her/his absence
Provide coverage for Supervisor in her/his absence
Responsibility for all supervisor respo nsibilities on smaller teams that do not have supervisor
Establish and maintain a network of key contacts from provider representatives to senior level management with various carriers and departments to expedite and encourage effective enrollment and billing execution
Assure that the department tracks and follows through on provider documents that are set to expire and notify customers timely
Other duties as assigned
Develop and maintain a working and effective knowledge of all functions performed by team
Develop and maintain a working knowledge of relevant payor billing requirements and reimbursement regulations
Interpret and an analyze data associated with Provider Enrollment payer regulations, keeping up with all mandates
Develop and maintain a working knowledge of all core systems(Epic) and ancillary systems (Avail ity, SAP, ECHO, Hyland, Cognos/ReportNet)utilized by team
Develop and maintain complete understanding of all operati onalpolicies and procedures relevant to team
Develop and maintain working and proficient knowledge of personal computer software required for fulfilling management responsibilities, including : Lotus Notes, Excel spreadsheets, Word processing, Access database, Visio flowchart, Powerpoint presentation, TeamTrack Change Cont rols, Pillar budget, SAP, I-forms, and APIPTO
Work requires 5 years of experience in business or other applicable experience. A master's degree in a related field, such as business or health administration, may be substituted for experience on a 1:1 basis.
Degrees, Licensures, Certifications
Certifications in patient access or patient accounting preferred.
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.