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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 Primary Care. 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.

 

Job Summary 

 

Oversight of the processes related to Medicaid eligibility primarily and alternative funding sources for uninsured patients (e.g. Medicaid, Affordable Care Act ins urance, Victims of Crime) at Duke hospitals and select ambulatory clinics. Management of the daily operations of the Medicaid Eligibility team responsible for screening uninsured patients, filing applications for potential programs, and monitoring application progress until resolution. Management of technology (computer hardware, phone systems, computer software) associated with the alternative funding processes.
 
 
Monitor proper operation of all assigned work queues (e.g. patient work queues, account work queues, follow up work queues). Analyze issues with work queue rules and claim edits/errors and coordinate resolution with the relevant operational and IT staff. Provide notification of new edits and edit changes via user notifications and staff educational meetings .
 
                                                                                                       
Work with PRMO IT, vendors, and other IT groups to implement new systems/applications that positively impact the operational and financial performance of the Medicaid eligibility processes. Monitor system/application performance to ensure effectiven ess and efficiency. Submit tickets for system breaks and/or enhancements. Assist with operational testing and validation of system changes p rior to release. 
 
 
Develop and monitor key performance indicators effectively using available data resources (e.g. dashboards, reports). Deliver performance results periodically to department and entity leadership, effectively communicating key drivers of high and low performance. Effectively use data resources to prioritize improvement opportunities and implement action plans. Maintain internal controls for processes and implement timely corrective actions to mitigate the risk of failed controls. 
 
 
Develop, implement, or maintain new staff training. Conduct an annual review of training modules for new and existing staff. Routinely monitor all safety, regulatory, and compliance related training reports. Routinely review trade related publications and mailings (e .g. Medicaid bulletins) for recent news and updates relevant to work processes; share information via staff meetings, entity meetings, and other appropriate forums.  

 

Work collaboratively with patient relation departments throughout the Health system (e.g. PRMO Customer Service, Patient Visitor Relations) to monitor customer feedback related to department services.  Develop strategies to minimize customer complaints.

 

 

Assist in development and maintenance of policies and procedures associated with department services.  Participate in an annual review and update to policies and procedures. 

 

 

Communicate individual performance on a routine basis with direct report(s).  Ensure performance reviews for department staff occur routinely, and provide feedback.  Confirm all department staff have a completed performance review and/or coaching conversation in accordance with the PRMO schedule for reviews.      

 

 

Attend and lead business meetings relevant to the successful operations of the functions within the department. 

 

 

 

 

Minimum Qualifications

 

 

Education

Bachelors degree required. Masters degree preferred.

 

Experience

 

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, Licensures, Certifications

 

Certifications in patient access or patient accounting 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.

 

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