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.
REMOTE POSITION: Monday - Friday
*** MUST RESIDE IN NORTH CAROLINA***
General Description of the Job Class:
Perform quality assurance reviews of accounts which impact revenue cycle activities as well as adherence to compliance and regulatory requirements
Compile, analyze and report on QA performance of departmental operating units, noting trends and making recommendations or conclusions which are in alignment with the financial performance of the Health System.
Review financial reporting and trends impacting reimbursements/cash projections (denials/write offs/performance dashboards); coordinate projects and quality assurance reviews based on trends; provide workflow recommendations for discovered deficiencies to improve reimbursement/cash projections
Track financial performance related to changes in workflow and/or recommendations
Provide front end registration support to outpatient clinics as needed.
Duties and Responsibilities of this Level:
70%
Investigate and resolve underpayment accounts on a daily basis
Analyze contracts against payer explanation of benefits to determine opportunities for additional payments
Engage with contracted payers to resolve accounts in a timely manner
Support and engage in monthly payer meetings/calls for any escalated revenue situations
Analyze and provide feedback for departmental specific reports
Utilizes account receivable knowledge and resources to ensure accurate and compliant billing and to recognize and resolve inconsistencies with underpayment workflow
Manage appropriate systems for accounts receivable and/or financial reporting and prepare written reports/summaries for leadership documenting trends and appropriate recommendations/conclusions including process improvements and optimization opportunities
Assist management in forecasting by providing historical information. Work with departmental Directors, Managers and appropriate personnel to ensure budgetary compliance< /p>
Trend and report on departmental performance indicators and goals. Ensure departmental goals are satisfied
Make recommendations to improve financial systems; perform in house audits of operating units; analyze deficiencies and report to manager/director.
Trend and assist in resolving No Surprise Act account reviews
20%
Responsible for any system upgrade testing/report outs associated with WQ assignment/under payments.
Assist with documentation support for any job aid updates/optimizations
Develop and provide job-specific training to new and existing employees wi thin department.
Assist in developing and defining short and long term departmental specific goals and objectives
Creation and development of work assignments including training assistance for new hires if needed
Maintain professional relationship with internal and external agencies and professional organizations concerning operations
10%
Participate and present trends to payer JOC and ad-hoc meetings.
Attend internal workgroup meetings and assist with documenting minutes.
Perform other related duties incidental to the work described herein
Minimum Qualifications
Education
High school diploma or equivalent is required, preferably supplemented by post-secondary courses in Accounting, Finance, Economics, Business Administration or a related field.
Experience
Four years of related experience in healthcare is required. A Bachelor's degree in a related field can substitute forthe experience requirement.
Degrees, Licensures, Certifications
N/A
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.
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.