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.
General Description of the Job Class
Coordinate, prepare and analyze complex accounts receivable and/or financial reports. Review and analyze trends, advising PRMO, DUHS and PDC leadership regarding conclusions and recommendations. Serve as expert resource for covered area.
Working Job Description for Patient Account Analyst
Manage appropriate systems for accounts receivable and/or financial reporting. Prepare written reports and analyses for PRMO, DUHS and PDC leadership highlighting trends and appropriate recommendations/conclusions.
Collaborates with assigned Revenue Manager(s) with monitoring professional and hospital revenue cycle performance; including trending, analyzing and resolving issues related to Pre-Billing Edits/DNBs, coding, registration and billing denials, late charges, and POS Cash Collections. Performs thorough analysis and provides explanation of KPI variances outside the acceptable deviations.
Serve as an expert resource to leadership in the decision-making process; playing an integral role in implementing and managing change related to area of expertise.
Performs thorough analysis, provides explanation and recommendations for specific billing problems within assigned Department(s). Prepares management reports. Reports and analyses are completed and distributed by assigned deadlines. Participate in/lead as appropriate monthly virtual revenue cycle teams to correct identified issues. Keeps current on third party payer regulations (e.g., Medicare, Medicaid, and commercial carriers.) Supports organization's efforts to maintain compliance with regulations and accreditation standards. Researches reimbursement rates by Payor and requests new charge codes as needed. Performs other special projects as assigned.
Maintain liaison with DUHS, PRMO and PDC management and staff, documenting reports and analyses and discussing results, trends and recommendations.
Is professional and courteous in all forms of communication. Responds to requests in a timely manner and keeps customers informed of progress. Presents information in a clear and concise manner. Works effectively with other PRMO and entity management staff in a team framework. Collaborates with assigned revenue manager(s) in consulting and advising physicians regarding billing problems and helps formulate plans for solving such problems. Collaborates with educating physicians on yearly CPT, ICD-9/ICD-10, HCPCS updates. Researches patient accounts in support of resolving customer service complaints/inquiries.
Conduct detailed research to identify trends, including a review of specifics in the appropriate accounts receivable and /or financial systems.
Collaborates with assigned revenue manager(s) in reviewing and trending charge and receipts to budget reports.
Provide support in special projects, including preparation of financial models to estimate reimbursement impacts of new programs or new and changing legislation related to Medicare Part B, Medicare Part A, Medicaid, Champus, and other third party reimbursement issues
Act as a technical resource to operational management and staff on the appropriate interpretation of accounts receivable and/or financial data. Coordinate and mentor staff regarding accounts receivable and financial systems, analyses, reports and policies/procedures.
Identify process improvements, including staff education/training, operational workflow modifications, system enhancements and external payer policy changes and work with appropriate personnel to implement those improvements.
Organize and lead committee meetings across DUHS, PRMO and PDC as it relates to accounts receivable and or financial data operation improvements.
May recommend various personnel actions including, but not limited to, hiring, performance appraisals, promotions, transfers and vacation schedules.
Perform other related duties incidental to the work described herein.
Required Qualifications at this Level
Bachelor's degree in business, healthcare administration, accounting, finance or a related field is required.
Four years of experience in healthcare accounts receivable, financial management, accounting or a directly related field is required.
Licensure, and/or Certification : None Required
Knowledge, Skills, and Abilities :
Data analysis and reporting Billing/Collections Insurance Claims Microsoft Office (Excel, Access, Word, PowerPoint) Good communication skills (verbal and written) are essential
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.