Lihue,
Durham, North Carolina
Whittier, California
Posted: 26-Jun-24
Location: Durham, North Carolina
Salary: Open
Categories:
Internal Number: 246589
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
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.
Manager of Clincal Trials Billing Integrity
Duke Health
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
General Description of the Job Class
Reporting to the Director of Revenue and Documentation Integrity, the Manager of Clinical Trials Billing Revenue Integrity plays a vital role in the direct oversight and implementation of compliant and accurate execution of research protocol directives and billing functions, clinical trial billing policies and procedures, and the tracking and reporting of high-dollar new-to-market therapies. Principally providing leadership and management of workflows through an efficiently structured process, reporting metrics impacting the health system, and 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 a Trials Billing department to support DUHS, including metrics, policies and procedures, monitoring programs, and education initiatives (10%)
Collaborate with external stakeholders; including the School of Medicine, DUHS Finance, DUHS Compliance, and other peers in the industry, to discuss current performance, prepare for changes to research billing policy guidance, and implement changes to research billing workflows. (20%)
Engage internal PRMO stakeholders; including HIM, HB, and PB Coding, Hospital, and Professional Billing and Collections, Pre-service Verification, and Revenue and Documentation Integrity, to establish operational workflows, facilitate payments for research claims, and correct charge capture errors. (20%)
Manage and lead a dynamic team of analysts and clinical trial specialists. Develop fully functional operating budget(s) to meet system goals. Responsible for the financial, service, and productivity performance of the department's 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 the Clinical Trials Billing team. (10%)
Oversee data analysis, tracking, and management reporting to substantiate positive, compliant net revenue impact from the core functional areas; present opportunities to improve compliant billing processes; and execute research protocol directives. (10%)
Identify, develop, implement, and maintain operating procedures that are consistent with effective internal control practices, compliance standards, and institutional policies (5%)
Perform other duties, responsibilities, and activities as assigned at any time to meet DUHS demands (5%)
Knowledge, Skills, and Abilities:
Strong and effective oral and written communication skills, with the 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, the ability to assess risks and implications to existing compliant revenue cycle functions, and the ability to strategically develop or modify system processes in response.
Ability to lead or direct multiple complex projects and activities in an ambiguous environment that promotes initiative, creativity, and a high level of productivity.
Ability to establish a productive team-based work environment that values the talents and abilities of each individual. Strong team-building, mentoring, coaching, and development skills are required. Demonstrated communication and presentation skills.
Ability to work collaboratively and proactively with cross-functional teams and departments to positively influence outcomes and achieve goals.
Resourceful and collaborative, with timely follow-up on critical external audits.
Proficient understanding of multiple reimbursement systems, including hospital-focused IPPS, OPPS, and Addenda, professional-focused MPFS, and overall price setting and research pricing.
Strong understanding of hospital and professional payer billing requirements.
Possesses and applies knowledge of healthcare clinical and administrative systems and processes to achieve organizational priorities. Has solid knowledge and proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook. Knowledge of Epic and Power BI is a plus.
Intermediate to expert knowledge of multiple healthcare applications and sources, including but not limited to EPIC or other EMR, Power BI, ChargeMaster, charge capture, charting, and claim edit systems, CPT/HCPCS, ICD-9/10 and associated edits, NCCI, and MUEs. Epic certification in the HB or PB revenue cycle is highly desired. Epic research module certification is required within 6 months of hire.
Minimum Qualifications
Education
A bachelor's degree is required. A master's degree is preferred.
Experience
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.
Preferred Experience
- Experience in clinical research and/or clinical research billing
- Epic Research module certification
- Prefer HB (hospital billing) or PB (professional billing) revenue cycle experience and/or certification
- Management experience, dynamic, focused on process improvement and employee development, skilled at motivating teams and working collaboratively with cross-functional teams.
Degrees, licenses, and certifications
Certifications in patient access or patient accounting are 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.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the 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 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.