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: The IP Risk Revenue Manager will oversee activities associated with Hospital Coding and quality, value based purchasing and IP Risk Adjustment.
Manage and coordinate activities for all Hospital Coding projects that are related to quality, value based purchasing and IP Risk Adjustment. Projects included but not limited to; Mortality Reviews, Service Line Reviews, Patient Safety Indicators, etc.
Continuously research and monitor payer regulations and quality methodologies; provide education to operational areas as applicable.
Coordinate with service line leaders to educate physicians; facilitated implementation of modifications to revenue cycle functions to meet changing payer requirements/regulations, e.g., new authorization requirements; changes in billing/claims requirements; LCDs. Coordinate strategies through Bulletin Review and other resources.
Facilitate Revenue Manager training around work/skills or career development topics (e.g., Report writing, Branding & Marketing, Communications, Project Management, Onboarding, Compliance/Regulation Interpretation, HL7 interfaces; how WQ logic works).
Develop and prepare/utilize reports to track operational performance across various quality /risk adjustment projects within Hospital Coding.
Investigate and manage revenue opportunities identified through reporting and analysis.
Perform root cause analysis and provide expert and creative solutions. Actions to be taken to achieve resolution include:
Assemble cross-functional team within PRMO (if applicable), Develop Revenue cycle-related project plan, maintain comprehensive issues lists with time lines and responsibilities clearly assigned, escalate issues through PRMO Senior Operational Leaders that require significant cross-departmental resources.
Assist in the development of reengineered best practice workflow processes and identify system optimization that improves revenue cycle performance
Work with revenue management, department, and PRMO operational managers to ensure newly implemented workflows and procedures support revenue cycle integrity.
Serve as EPIC System knowledge source for documentation, coding and charge capture functions (charge capture, reconciliation, and corrections for procedures, medications, and supplies as appropriate) with specific applications (interface between Maestro & PRMO claims processing needs)
Coordinate all Maestro Care revenue cycle-related system setup/modifications necessary to bring up new services. Manage to completion. Specific functions include but not limited to:
Work with Maestro Care trainers and administrative leadership (operations, medical directors, etc.,) to educate and train providers and staff about new services; specifically charge capture and their role related to revenue cycle
Work with Maestro Care Teams to implement service-specific charge-capture methodology.
Work with PRMO/Maestro Care professional and/or technical billing teams to determine need for/request updates to charge router logic; charge review logic/work queue definition; claim logic
Immediately after go-live of new services, validate revenue cycle functions operating as expected: confirming accurate billing; monitoring specific patient examples for denials/payments.
Notify other PRMO operational areas of new service so they can determine what, if any changes are required, e.g., provider enrollment; service access/preregistration.
Attend Quality/IP Risk Adjustment meetings with providers and service line leaders; provide updates regarding outcomes of quality related projects.
Review and compile summaries based on clinical and quality reviews of the following areas:
Mortality Reviews, DIHI Reviews, 30-day Death Reviews, REM Second Level Reviews, Fair Code Reviews etc.
Acts as a liaison between providers and operational management for all inpatient quality/risk functions.
Facilitates revenue cycle collaboration and service line specific strategic planning activities
Review and recommend changes/updates to the department workflows to maximize efficiency within the group.
Review key metrics from Performance Services, Vizient and external agencies, in collaboration with PRMO Managers and Providers.
Participate in routine meetings with CFOs, AVPs, and other Departmental and Revenue Cycle to provide updates on current revenue cycle issues/priorities.
Perform other related duties incidental to the work described herein.
Six years of experience in the healthcare industry is required.
Thorough understanding of IP Risk methodologies; Vizient, Elixhauser, USNWR rankings, PSI initiatives etc.
Degrees, Licensure, and/or Certification:
BA, BBA, RN, CPC/CCS, RRA, or CPA, RHIT or RHIA or higher
Knowledge, Skills, and Abilities:
Experience in these areas is preferred: Coding, Auditing, Quality Reviews (Mort/PSI/Service Line). Must have understanding of USNWR rankings, and EPIC logic.
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.