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.
This position is 100% remote. All Duke University remote workers must reside in one of the following states or districts: Arizona; California; Colorado; Connecticut; Florida; Georgia; Hawaii; Illinois; Indiana; Maine; Michigan; Maryland; Massachusetts; Montana; New Hampshire, New Jersey; New York; North Carolina; Ohio; Pennsylvania; South Carolina; Tennessee; Texas; Virginia; Washington (State); or Washington, DC.
Provider Enrollment
General Description of the Job Class:
Contribute to the achievement of the DUHS mission through the development and leadership of performance improvement activities in the operational and/or clinical arenas. Assure continual compliance with regulations and accreditation standards through monitoring activities and the design and implementation of strategies to enhance compliance. Responsible for billing and claims functions and overall management of the provider enrollment processes associated with enrolling applicable Health Systems and Physicians for all clients. Oversee and coordinate Provider enrollment-related professional and hospital insurance collections and accounts receivable to maximize reimbursement, achieve A/R aging targets, minimize avoidable/controllable write-offs, and accomplish results as cost-effectively as possible.
Duties and Responsibilities of this Level:
A/R Management
Drive independent revenue cycle operational decisions to resolve complex issues impacting collections, patients, and providers.
Prepare weekly report summarizing inventory statistics, staff productivity and collections performance, and accounts receivable aging trends
Identify deficiencies in staff performance and backlogs in inventory statistics promptly and take action to address the addresses' outstanding issues
Work with a denial analyst to monitor denial rate trends and identify & implement opportunities to reduce post-billing denial rates
Review and approve write-off requests per policy. Provide feedback to supervisor and staff if write-of requests are not in compliance with policy requirements
Review avoidable write-off trends and identify and implement opportunities to reduce avoidable write-offs.
Work with other PRMO management and DUHS leadership to improve collections, reduce accounts receivable, reduce denial rates, and reduce avoidable write-offs through issue identification, research, communication, and process improvement
Pull reports to review outstanding insurance accounts receivable and take necessary action to address backlogs or to identify unworked accounts
Define criteria and set up insurance work files/worklists to ensure timely and comprehensive collection of all accounts receivable
Assign staff to all insurance work files/worklists to ensure appropriate and equitable resource allocation and prioritization to our understanding of the workload
Review daily/weekly/monthly system reports summarizing inventory and staff performance to identify outstanding issues, including:
Inventory reports
Provider Enrollment status reports
Issue log maintenance
Prepare operational status updates on High Balance accounts for the weekly management meeting
Prepare a monthly summary of accounts receivable by provider/payor for director review, with an explanation for changes in performance and specific plans to address deficiencies
Research the rational and system issues identified by staff and develop/implement solutions for performance improvement
Staff Management
Oversee the supervisor's efforts in posting, recruiting, and hiring new employees
Oversee supervisor's efforts to provide job-specific training to new and existing employees
Oversee supervisor's mid-year and year-end performance evaluations of employees
Post, recruit , and hire direct reports (supervisors and reimbursement specialists)
Provide job-specific training to new and existing direct reports
Conduct mid-year and year-end performance evaluations and provide feedback to direct reports
Review results of monthly employee quality reviews and take action on underperforming staff results
Ensure that all provider enrollment processes are completed in an accurate, timely manner and that credentials are up-to-date
Oversee the claims billing and provider enrollment functions to ensure appropriate logic is in place for revenue success
Oversee all revalidations and verifications related to enrollment to ensure timely completion
Support the supervisor in oversight of completing enrollment packets for providers and d groups in an accurate and timely manner
Assist with the development of job-specific training programs for all staff within the team
Identify and implement programs to develop direct reports and associated staff for career development
Hold monthly team meetings to review team performance, share new policies and procedures, and keep employees informed about PRMO updates
Identify and implement opportunities for improvement of staff morale
Ensure compliance with all PRMO and DUHS personnel policies
Policy & Procedure and Internal Controls
Develop and maintain documentation summarizing workflow processes and operating policy & procedure for all functions handled by the team.
Document and review changes to all operational processes with the director before implementation.
Develop internal controls for all operational processes and ensure the timely completion of internal control processes by staff, supervisor, and manager on an as-needed periodic basis
Managerial Duties
Prepare and submit for approval an annual budget for the team
Review actual vs. budgeted variances every month and provide a summary of the explanation.
Identify negative budget variances and provide an explanation and gameplan plan for addressing deficiencies
Identify opportunities to reduce or minimize personnel and non-personnel costs
Respond to inquiries from PRMO and DUHS leadership, peers, and staff in a timely, accurate, and comprehensive manner (ie: 24-48 hours, depending on circumstances)
Adhere to all PRMO and DUHS revenue cycle policies and regulations
Respect and maintain confidentiality regarding patient/guarantor financial data and patient medical data consistent with HIPAA standards
Validate and reassess productivity standards through observations, documenting, and sharing for management review and recommend resolution/feedback.
Provide coverage for the director in her/his abs.
Provide coverage for the supervisor in her/his abs.
Responsibility for all supervisory responsibilities for staff that do not report to the supervisors
Establish and maintain a network of key contacts from provider representatives to senior-level management with various carriers and departments to expedite and encourage effective enrollment and billing execution
Assure that the department tracks and follows through on provider documents that are set to expire and notify customers timely.
Other duties as assigned
Technical Expertise
Develop and maintain working and effective knowledge of all functions performed by a team
Develop and maintain working knowledge of relevant payment billing requirements and reimbursement regulations
Interpret and analyze data associated with Provider Enrollment payer regulations, keeping up with all mandates
Develop and maintain a working knowledge of all core systems (CredentialStream, EcHo, Epic) and ancillary systems (SAP, Hyland, etc.) utilized by the team
Develop and maintain a complete understanding of all operational policies and procedures relevant to the team
Develop and maintain working and proficient knowledge of personal computing software required for fulfilling management responsibilities, including Outlook, Sharepoint, Microsoft 365 applications (Teams, Lists, Planner, Excel, Word, PowerPoint, etc.), ServiceNow, SAP, I-forms, and API PT O
Five years of experience in the healthcare industry is required.
Management experience is preferred
Knowledge of provider enrollment processes and requirements for commercial insurance companies and CMS Federal and state Guidelines related to enrollment and renewal policies are preferred
Knowledge of accounts receivable and revenue cycle management required
Familiar with group and provider documents, ie: medical license, medical school practices, board certifications, etc. preferred
Knowledge of claims billing payer regulations preferred
Work requires 5 years of experience in business or other applicable experience. A master's degree in a related field, such as business or health administration, may be substituted for experience on a 1:1 basis.
Degrees, licenses, and certifications
Certifications in patient access or patient accounting are preferred.
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.