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: Supports the management team in PreService Verification in issue identification, analysis, and implementation of process improvement opportunities to achieve balanced scorecard objectives related to verification of eligibility/coverage, authorization, and medical necessity in a timely manner to minimize adverse impact on patients and providers - and reduction of downstream denials and avoidable write-offs. The majority of the Analyst's focus is proactive and independent in nature: reviewing revenue cycle performance data at a macro and micro level to identify outlier (problem/deficiency) results, pulling more detailed data to research the underlying issues, formulating operational and system solutions to improve results, and working with leadership to implement those recommendations.
Manage appropriate systems for accounts receivable and/or financial reporting.
Prepare written reports and analyses for PRMO, DUHS and PDC leadership highlighting trends and appropriate recommendations/conclusions. Serve as an expert resource to leadership in the decision-making process.
Plays an integral role in implementing and managing and change related to area of expertise.
Maintain liaison with DUHS, PRMO and PDC management and staff, documenting reports and analyses and discussing results, trends and recommendations. Conduct detailed research to identify trends, including a review of specifics in the appropriate accounts receivable and /or financial systems.
Act as a technical resource to operational management and staff on the appropriate interpretation of accounts receivable and/or financial data.
Coordinate and mentor staff regarding accounts receivable and financial systems, analyses, reports and policies/procedures. Identify process improvements, including staff education/training, operational workflow modifications, system enhancements and external payer policy changes and work with appropriate personnel to implement those improvements.
Organize and lead committee meetings across DUHS, PRMO and PDC as it relates to accounts receivable and or financial data operation improvements.
May recommend various personnel actions including, but not limited to, hiring, performance appraisals, promotions, transfers and vacation schedules.
Perform other related duties incidental to the work described herein . Knowledge, Skills and Abilities Data analysis and reporting Billing/Collections Insurance Claims Microsoft Office (Excel, Access, Word, Powerpoint)Good communication skills (verbal and written) are essential
Bachelor's Degree in business, healthcare administration, accounting, finance or a related field is required
Minimum of four years of applicable experience. Previous experience successfully managing complex projects involving multiple stakeholders with a consistent track record of delivering on time, or high quality results preferred. A Master's degree in a related field can substitute two years of experience on a 1:1 basis.
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.