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
Reporting to the Director of Revenue and Documentation Integrity, the Manager of Revenue Integrity plays a vital role in the direct oversight and implementation of all revenue integrity functions, policies and procedures within the Revenue Integrity department. Principally providing leadership and management of work flows through an efficiently structured process, reporting metrics impacting the health system, while subscribing to a shared sense of vision, values and expectations of the Duke University Health System.
Duties and Responsibilities of this Level
Establish and maintain Revenue Integrity department (including CDM and Charging Systems Team) to support DUHS, including metrics, policies and procedures, monitoring programs and education initiatives (10%)\
Responsible for ensuring quality, timely production and resolution of external audit reviews (CMS, QIO, Managed Care and other Payors) that impact institutional and professional Coding/Charge Capture/CDM (NCD-LCD) and Billing/Follow up services; reporting appropriately (20%)
Identify, develop, implement and maintain operating procedures, which are consistent with effective internal control practices, compliance standards and institutional policies (10%)
Prepare and consistently evaluate work measurement criteria and manage enforcement of performance standards; with ability to implement necessary reassignment and changes effectively; performing daily audits (20%)
Develop fully functional operating budget(s) to meet system goals. Responsible for the financial, service and productivity performance of the departments associates, overseeing hiring, orientation and development of new employees, assigning work and conducting performance evaluations. (20%)
Identify issues and/or enhancements for the operating tools utilized by team members within Revenue Integrity team
Oversee data analysis, trending and management reporting to substantiate positive, compliant net revenue impact from the core functional areas; presenting on opportunities to improve reductions in probes, denials and avoidable write-off measures
Promote and emulate an integrated patient-centric and customer service focus within the department through collaborative strategic relationships with finance, Utilization and Case Management HIM, Coding Operations, Professional and Technical Billing and DUHS/PDC Compliance, CDM, Revenue Management and applicable vendors (15%)
Perform other duties, responsibilities, and activities as assigned at any time to meet DUHS demands (5%)
Six years of experience in the healthcare industry is required
Degrees, Licensure, and/or Certification:
RHIT/RHIA, highly recommended. CCS, CHFP and EPIC Certifications also preferred
Knowledge, Skills, and Abilities:
Strong and effective oral and written communication skills, with ability to make sound recommendations through exceptional interpersonal interaction
Ability to problem solve; compile, analyze and evaluate complex data and reports to influence solutions
Expert understanding of CMS and insurance regulatory mandates and probes, with ability to implement into system processes, via NCD/LCD and bulletin payor reviews
Resourceful and collaborative with timely follow-up on critical external audits
Proficient understanding of multiple reimbursement systems including Hospital System Focused, IPPS, OPPS and Fee Schedule
Strong understanding of hospital and professional payer billing requirements.
Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook, WORD and EXECL
Working knowledge of multiple healthcare applications and sources including but not limited to EPIC, nThrive (MedAssets), CDM, CPT/HCPCS, ICD-9/10 and associated edits NCCI and MUE
Manage/lead dynamic team of analyst and reimbursement specialist with charge capture understanding
Distinguishing Characteristics of this Level
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
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.