Revenue Manager

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Duke Health Integrated Practice

Duke Health Integrated Practice comprises more than 110 primary and specialty outpatient clinics, extending the reach of the Duke Health mission across the state of North Carolina.

JOB SUMMARY

Reporting to the Senior Revenue Manager, the revenue manager coordinates activities performed by the staff responsible for charge capture, coding, charge entry, insurance follow up, reimbursement analysis, or other PRMO function within 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 assigned clinical area.

Review and recommend changes/updates to the departments charge master(s) to maintain fees at levels that maximize reimbursement. Review and recommend changes to department's charge capture documents to facilitate accurate and comprehensive billing in compliance with annual CPT/HCPCS and ICD-10 updates. Identify revenue cycle problems, research/analyze data to resolve issues, identify and select alternatives to address outstanding issues, and implement solutions for improvement.

Work with financial analyst, 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, Patient Revenue Management Organization (PRMO), Duke University Health System (DUHS), Duke Health Integrated Practice, 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. Train, direct, and coordinate activities of assigned financial analyst /or other employees.

Perform other related duties incidental to the work described herein.

The Revenue Manager serves as a liaison among PRMO, Operational Owners and Maestro Care Clinical/Billing analysts to assist in the design, development, maintenance, training and evaluation for assigned Maestro Care clinical and business systems to support the revenue cycle. This position will be primarily responsible for design/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.

JOB DUTIES AND RESPONSIBILITIES

Revenue Management

Manage revenue cycle-related inquiries

• Serve as Point Person/Service Line Resource (Liaison)
• Respond, research and resolve revenue cycle-related inquiries pertaining to 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 accounts in assigned Charge Router, Charge Review. Claim Edit, and Follow-Up WQs

Monitor & manage from 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-off, and full transaction write-offs; deleted charges. Will also perform ad hoc analyses as requested, e.g., high-dollar drug reimbursement; service/program/code specific reimbursement; actual charge to budget charge variance
• 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; facilitated implementation of modifications to revenue cycle functions to meet changing payer…