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Posted: 12-Jun-25
Location: Durham, North Carolina
Categories:
Internal Number: 258449
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.
Job Description
Coordinate activities of staff responsible for charge capture, coding, charge entry, insurance follow-up, reimbursement analysis, or other PRMO functions for the assigned clinical area. Monitor performance for staff responsible for appointment scheduling, registration, clinic check-in, and clinic collections. Develop and prepare /utilize reports to track financial and operational performance across the entire spectrum of the revenue cycle for the assigned clinical area.
Review and recommend changes/updates to the department's charge master(s) to maintain fees at levels that maximize reimbursement. Review and recommend changes to the department's charge capture documents to facilitate accurate and comprehensive billing in compliance with annual CPT-4 and ICD-9 updates. Identify revenue cycle problems, research/analyze data to resolve issues, identify and select alternatives to address outstanding issues, and implement improvement solutions. Work with financial analysts, physicians, and administrative leadership to educate and train providers and staff about coding and other outstanding revenue cycle issues.
Act as a liaison to management and staff in the designated clinical area, PDC, PRMO, DUHS Hospitals, and third-party payers on revenue cycle activities for assigned areas. Continuously research, monitor, provide education, and implement payer regulations and guidelines related to revenue management activities of the assigned clinical area. Coordinate revenue management orientation and educational activities of clinical personnel, including providers and staff, about coding and other outstanding revenue cycle issues. Develop and utilize management models to monitor productivity and quality of staff performance. Develop and manage the budget for the staff and activities that are directly managed. Train, direct, and coordinate activities of assigned financial analyst /or other employees. Perform other related duties incidental to the work described herein.
The PRMO Revenue Manager serves as a li aison among PRMO, Operational Owners, and Maestro Care Clinical/Billing analysts to assist in the design, development, maintenance, training, and evaluation of assigned Maestro Care clinical and business systems to support the revenue cycle. This position will be primarily responsible for the design/r re-design of workflow, working with Maestro Care Build teams, testing, and validating of application functionality specifically related to charge capture/billing. This position will coordinate all revenue cycle issues that arise for their application area and must be very knowledgeable of DUHS/PRMO policies, procedures, and business operations.
Revenue Management
Key Accountabilities
Duty Statements
Performance Standards
Revenue Management
Manage revenue cycle-related inquiries
Must be able to communicate effectively, provide timely responses, and identify resources to resolve
inquiries
Monitor & manage key performance indicators
Must be able to perform data anal ysis
Monitor & manage reimbursement changes
Must be able to interpret policies
Percent of Time30%
Revenue Cycle Leadership
Key
Accountabilities
Performance Standards
Revenue Cycle Leadership
Facilitate revenue cycle collaboration and strategic planning activities
Coordination of activities is expected to be carried out
out with minor supervision
Coordinate and chair revenue-oriented
workgroup activities and meetings
Must be capable of setting priorities and working under pressure
Manage communications a mong PRMO, hospitals, and physi cian practices
Must be able to facilitate meetings of multi-disciplinary teams
Arrange revenue cycle training activities
Must be able to understand the basics of topics
Percent of Time
30%
Project Management
Key Accountabilities
Performance Standards
Project Management
Manage and prioritize revenue and/or
compliance requests
Must be able to manage projects simultaneously
Develop and manage action plans & timelines
Must be able to organize and keep deadlines
Identify and recruit appropriate resources
Must be able to develop strong relationships
Develop creative solutions
Must be able to be process-oriented
Percent of Time
30%
Epic Systems Advisory
Key
Accountabilities
Duty Statements
Performance Standards
Project Management
Epic Systems applications
Must be able to investigate charges and claims
information, and navigate information systems
Percentage of Time
10%
Specific Job Duties/Key Accountabilities
Revenue Management
Duty Statements
Details
Manage revenue cycle-related inquiries
Serve as Point Person/Service Line Resource (Liaison)
Respond, research, and resolve revenue cycle-related inquiries about assigned MC applications
Manage assigned Service Now tickets
Specialize & manage revenue cycle functions and Epic Systems applications
Serve as EPIC System knowledge source for charge capture functions (charge capture, reconciliation, and corrections for procedures, medications, and supplies as appropriate) with specific applications
(interface b/w Maestro & PRMO claims processing needs)
Provide training on charge capture, reconciliation, and correction as needed
Resolve< span> accounts in the assigned Charge Router, Charge Review. Claim Edit, and Follow-Up WQs
Monitor & manage key performance indicators.
Utilize standard reports and/or develop new reports to track revenue cycle performance for assigned applications' clinical services. Areas of focus will include denial rates, avoidable write-offs, full transaction write-offs, and deleted charges. Will also perform ad h oc analyses as requested, e.g., high-dollar drug reimbursement; service/program/code specific reimbursement; actual charge to budget
Review key metrics from scheduling to billing & collections, in collaboration with PRMO Managers.
Identify issues through ongoing monitoring of departmental metrics and/or through routine meetings.
With key operational managers within PRMO to facilitate communication.
Monitor & manage reimbursement changes.
Continuously research and monitor payer regulations; provide education to operational areas as applicable; coordinate with PDC revenue managers to educate physicians; facilitate implementation of modifications to revenue cycle functions to meet changing payer requirements/regulations, e.g., new authorization requirements; cha nges in billing/claims requiremen ts; LCDs.
Monitor payer regulations & coordinate strategies through Bulletin Review and other resources.
Percent of Time
30%
Revenue Cycle Leadership
Duty Statements
Details
Facilitate revenue cycle collaboration and strategic planning activities
Serve as Duke Revenue Cycle Management & Integration
activities (reduce redundancies) and keep senior leadership informed
Participate in routine meetings with CFOs, AVP, and Reimbursement Revenue Accounting to provide updates on current revenue cycle issues/priorities
Providing service line-specific strategic planning/priorities to PRMO leadership through Revenue
Manager Councils/Operations Meetings
Coordinate and chair revenue-oriented workgroup activities and
meeting
Share operational changes to/from PRMO to the hospital and physician practice
Develop or participate in focused workgroups to address topics such as registration, billing &
collections, coding, and charge capture, Maestro Care applications.
Facilitate discussions and strategies to address operational issues.
Escalate issues as needed.
Manage communications among PRMO, hospitals, and physician practices.
Managing communications between PRMO and Hospital Operational Owners and Providers
Organize and lead workgroups to routinely meet with Operations regarding PRMO function, issues, trends, etc., affecting revenue cycle performance
Actively participate in service line-specific strategic planning around revenue cycle prioritization and planning.
Arrange revenue cycle training activities
Coordinate training for non-charge capture revenue cycle topics as needed
Facilitate Revenue Manager training around work/skills career development topics (e.g, Report
writing, Branding & Marketing, Communications, Project Management, Onboarding, Compliance/Regulation Interpretation, HL7 interfaces; how WQ logic works)
Percent of Time
30%
Project Management
Duty Statements
Details
Manage revenue and/or compliance requests.
Manage request-based Revenue Enhancement and/or Compliance process improvement Projects (e. g.,
New, Modified, and Discontinued Services Request Management, including new services and locations
Manage routine-based: Annual CP T Updates: coordinate, working with Health System Operations Managers in assigned applications: DUHS Revenue Management and PRMO CDM Team, Hospital.
Finance, and PDC Revenue Managers, including an Annual review of charges and DEPs
Investigate and manage revenue opportunities identified through reporting and analysis.
Develop and manage action plans & timelines.
Perform root cause analysis and provide expert and creative solutions. Actions to be taken to achieve
Resolution includes:
Assemble a cross-functional team within PRMO (if applicable), develop a Revenue cycle-related project plan, maintain a comprehensive issues list with timelines and responsibilities assigned, and escalate
issues through PRMO Senior Operational Leaders that require significant cross-departmental resources.
Assist in the development of re-engineered best practice workflow processes and identify system
optimization that improves revenue cycle performance
Work with revenue management, department, and PRMO operational managers to ensure that newly implemented workflows and procedures support revenue cycle integrity
Coordinate all Maestro Care revenue-cycle related system set-up/modifications necessary to bring up
new services. Manager to completion. Specific functions include, but are not limited to:
Identify and recruit appropriate resources
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.
Work with PRMO/Maestro Care professional and/or technical billing teams to determine the need
for/request updates to charge router logic, charge review logic/work queue definition, and 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 the new service so they can determine
Example subjects:
o Master File creation record creation/updates: billing provider record (SER), department Record (DEP), bill area record (BIL), and charge codes (EA P)
o New charge code creation (as applicable) - assist department operational manager in determining if new charge codes are needed (department manager submits request)
o Charge capture methodology validation/updates - specific tasks dependent on charge capture method employed: update charging preference lists; work with Maestro Care application owner to update flowsheets; create/update orderable; confirm linked chargeable; work with PRMO coding
Staff to ensure awareness of new services/charge codes; Develop creative solutions
Utilize knowledge in revenue cycle and system applications to investigate root causes of problems, and
guide the process to fix issues
Lead multi-disciplinary teams in brainstorming activities to develop sustainable solutions to emergent and long-standing problems.
Percent of Time
30%
Epic Systems Advisory
Duty Statements
Details
Specialize & manage revenue cycle functions and Epic Systems
applications
Must be able to investigate charge and claim information, and navigate information systems
Percent of Time
30%
Minimum Qualifications
Ideal candidates will be able to balance the above tasks while maintaining flexible, friendly interaction with Operational and Hospital Leadership. The ability to work independently, proactively, and adapt appropriately to changing priorities is a must.
Education
Bachelor's degree required. Master's degree preferred.
Experience
At least 6+ years of relevant Healthcare experience, preferably in Charge Integrity, is required.
Strong leadership capabilities with demonstrated ability to lead, motivate, and collaborate effectively with Hospital leadership.
Strong oral and written communication skills.
Degrees, Licensures, Certifications
Coding certification (e.g. CCS, CPC, RHIA, RHIT), HFMA CHFP (Certified Healthcare Professional), CRCR (Certified Revenue Cycle Representative) preferred
Minimum Qualifications
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetici nformation, national origin, race, religion, sex (including pregnancyand pregnan cy related conditions), sexual orientation or militarystatus.
Duke aspires to create a community built on collaboration,inno vation, creativity, and belonging. Our collective success depends onthe robust exchange of ideas-an exchange that is best when the richdiversity 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 andDuke University Healt h System may include essential job functions thatrequire specific physic al and/or mental abilities. Additionalinformation and provision for requ ests for reasonable accommodation willbe provided by each hiring departm ent.
Education
Bachelor's degree required. Master's degree preferred.
Experience
Six year s of experience in the healthcare industry is required.
Degrees, Licensures, Certifications
BA, BBA, RN, CPC, RRA, or CPA, or high er
Duke is an 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 (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends onthe 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 essential job 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.