Wilkes-Barre, Pennsylvania
Wilkes-Barre, Pennsylvania
Wilkes-Barre, Pennsylvania
Wilkes-Barre, Pennsylvania
Pittston, Pennsylvania
Wilkes-Barre, Pennsylvania
Great Falls, Montana
Posted: 15-Apr-26
Location: Durham, North Carolina
Categories:
Internal Number: 266233
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.
Patient Revenue Management Organization
Pursue your passion for caring with the Patient Revenue Management Organization, which is the 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 for Duke Health.
General Description of the Job Class
Reporting to the Director, Revenue and Documentation Integrity, the Senior Revenue Manager has strategic oversight of and accountability for the Revenue Management/Charge Integrity team, who is the charge capture liaison between revenue cycle and clinical operations. The Senior Revenue Manager is a dynamic, trusted leader who provides guidance to revenue managers charged with capture revenue cycle projects and provides strategic direction to maximize reimbursement and mitigate revenue leakage; establishes, monitors and reports revenue cycle activities in compliance with federal and state laws and payer-specific billing requirements.
Duties and Responsibilities of this Level
Leadership & Oversight
- Lead the monitoring, advisement and guidance of facility and designated professional clinical department charge capture processes.
- Lead, coach, and mentor revenue managers and patient account and revenue integrity analysts; provide career development and performance evaluations, the latter of which focuses on developing relationships and trust, accountability and growth. By engaging the strengths and talents of each team member, we ensure a strong, trusted team capable of optimal clinical service line support.
- Foster collaboration and relationships across PRMO, finance, clinical departments, and operational leadership to ensure revenue integrity.
Strategic & Operational Management
- Guide revenue managers in the development, implementation and enhancement of charge capture workflows and best practices.
- Provide modeling and strategic guidance to the revenue managers regarding the identification of revenue cycle issues, performance of root cause analyses and implementation of mitigation strategies.
- Serve as a subject matter expert for charge capture and revenue cycle compliance and ensure revenue managers provide charge capture subject matter expertise.
- In collaboration with the director and revenue managers, provide pivotable oversight, guidance and contribution to the Revenue Cycle Analysis Committee.
- Work synergistically with the payer relations team to advocate and support escalation of revenue manager-identified inappropriate payer policies, denials or claim adjudication.
- Ensure appropriate escalation to the director and managed care of any payer policy or payment concern.
- Keeps the director informed of clinical charge capture wins, concerns, opportunities and mitigation strategies.
Reporting & Analytics
- Produce and analyze complex revenue cycle reports; identify trends and opportunities for improvement.
- Oversee the monitoring of charge capture outcomes and ensure the revenue manager follows up with clinical service areas regarding identified concerns.
- Provide actionable insights and guidance based on data analysis.
- Seek and develop opportunities to enhance reporting and data visuals.
- Train and mentor team members and operational leaders on interpreting and leveraging data for decision-making.
Project Management
- Champion and ensure revenue manager accountability for the development, monitoring and reporting of margin improvement initiatives by assigned clinical service areas or related areas of concern.
- Ensure revenue manager engagement and leadership of charge capture-related projects, including system upgrades, workflow redesign, and regulatory updates.
- Coordinate the revenue management/charge integrity support for annual NTAP, CPT/HCPCS and ICD updates to ensure chargemaster accuracy.
Education & Communication
- Develop and deliver training programs for staff and providers on charge capture and revenue cycle processes.
- Provide direction and empowerment of revenue managers to communicate regulatory changes and payer requirements to stakeholders.
Level Characteristics
N/A
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, 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 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 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.
Education
Bachelor's degree required. Master's degree preferred.
Experience
Eight years of experience required, of which 5 of those years should be in the healthcare industry
Degrees, Licensures, Certifications
BA, BBA, RN, CPC, RRA, CPA, or higher
Knowledge, Skills, and Abilities:
Hospital revenue cycle experience required. A combination of back-end, front-end and middle revenue cycle experience is strongly preferred.
The ideal candidate would be an energetic, strategic and dynamic self-starter with a strong affinity for executive presence and a proven ability to build trust and influence others. Demonstrated strong communication and presentation skills.
Proven ability to easily navigate the political complexities of a large organization and use knowledge of organizational culture to achieve and influence outcomes and match the tenor of stakeholders and meetings.
Broad experience in healthcare management, healthcare operations, change management, and systems preferred.
Possesses and applies knowledge of healthcare clinical and administrative systems and processes to achieve organizational priorities. Has intermediate to expert knowledge and proficiency with Microsoft Office applications, including Word, Excel, OneNote, PowerPoint, and Outlook. Knowledge of Epic and Power BI is a plus.
Broad knowledge is required of reimbursement methodologies-APC, DRG and third-party reimbursement guidelines and procedures. Understanding and working knowledge of hospital and professional coding (CPT, HCPCS, ICD10), chargemaster and charge capture systems, IPPS, OPPS, MPFS, price transparency, payer regulations, managed Medicare rules, and NC Medicaid.
Ability to transform financial information into business intelligence through analysis and integration of qualitative and quantitative data and translate information into easily interpretable visuals is required. Working knowledge of large revenue cycle systems and metrics.
Must possess the ability to apply broad knowledge to new circumstances to add value and perspective. Exhibits a customer-service orientation; anticipates, understands, and addresses customer and stakeholder needs promptly.
Experiencing managing people, including a proven ability to lead and manage a professionally diverse team. Ability to establish a productive team-based creative work environment that values the talents and abilities of each individual. Strong team championing, creative mentoring, coaching, and development skills are required.
Ability to lead or direct multiple complex projects and activities in a fast-paced, ambiguous environment that promotes initiative, creativity, and a high level of productivity.
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 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.
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.