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.
Edit Prevention Analysis– 40%
Manage edit prevention opportunities identified through reporting, trending and analysis.
Perform detailed analysis to identify trends, root cause, and process improvement strategies to assist in improving and enhancing DNB errors, Stop Bills, Claim Errors (Maestro Care and SSI), Electronic Rejections (277 and RTP) for Hospital Billing and Collections.
Monitor KPIs (Maestro Care Dashboards, SSI, WQs, etc) to evaluate clean claim rates and inventory related to edits.
Develop and maintain appropriate measurements for edit trending and ROI tracking specific to edit prevention.
Ensure compliance with billing guidelines related to claims processing and payer regulations.
Work with internal and external teams to support and develop business solutions. Use professional knowledge, judgment and analysis in making decisions or recommending a course of action that meets business needs.
Submit, monitor, manage and prioritize Service Now tickets related to edit prevention requests.
Partner with DHTS, operational teams, and staff to develop strategies for edit prevention strategies.
Lead cross-functional teams and maintain issues log and trending related to edit prevention opportunities.
RPA Oversight (40%)
Develop, monitor, and maintain complex system logic requirements related to Claim Status Automation (RPA).
Perform analysis and identify trends related to Claim Status Automation. (RPA)
Manage daily, weekly, and monthly vendor performance related to claim status automation.
Audit and validate findings from RPA Claim Status Automation to ensure appropriate responses are being received.
Evaluate and monitor no response follow-up WQ logic to ensure appropriate qualification of accounts.
Monitor payment response turn-around time from payers.
Develop and maintain RPA reporting and trending over time to evaluate performance and ROI.
Develop and maintain a working knowledge of relevant payor portal websites which will assist with analysis and validation of RPA performance.
Summarize and present monthly RPA results to management and leadership.
Partner with Operations Improvement for continued identification of RPA opportunities.
Perform timely testing and post implementation validation of operational workflows related to Service Now requests.
Complete documentation requirements related to testing that includes both positive and negative outcomes.
Understand and translate the business needs into system configuration and workflow validations.
Partner with operational teams to translate technical information into operational, non-technical language.
Develop and maintain a working knowledge of all core systems and ancillary systems by team. (Epic, SSI, OnBase, Payer Portals, etc)
Develop and maintain working and proficient knowledge of personal computer software required for fulfilling responsibilities. (MS Excel, Word, Powerpoint, Visio, Email, Sharepoint, Box, etc)
Preferred Qualifications at this Level
Education/Training: Bachelor's degree in a related field, or equivalent combination of education and technical experience required.
Experience: Four years of related experience is required. Experience working with Epic, SSI and other software and infrastructure is preferred.
Skills: Task Management
Ability to prioritize work coming into the team
Ability to work independently to accurately complete complex tasks
Ability to lead small projects and contribute to large projects
Reprioritize personal tasks as changes in project goals or requirements are communicated
Ability to follow standard practices to meet set timelines and proactively seek guidance when due dates are at risk
Ability to balance workload across multiple concurrent projects
Ability to adapt individual work style in consideration of needs and team dynamics
Commitment to share information and solicit input and ideas from other team members
Commitment to building strong working relationships with team members, service providers, and customers
Commitment to building and maintaining strategic alliances with operational areas and vendors across Duke
Ability to adapt communication style, timing, and content to the audience in order to effectively convey complex technical messages to a variety of audiences
Ability to synthesize data from multiple (appropriate) sources and make sound decisions
Ability to identify risks of negative outcomes, measure impact, and recommend mitigations
Ability to recognize when to escalate and minimize risk through corrective action
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 University 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.
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.