Revenue Manager, Pediatrics / Adult Ambulatory - Remote, M-F

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About the Role

The Patient Revenue Management Organization (PRMO) is the fully integrated, centralized revenue cycle organization supporting the entire health system in streamlining the revenue cycle, including scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.

Reporting to the PRMO Senior Revenue Manager, the revenue manager coordinates activities performed by staff responsible for charge capture, coding, charge entry, insurance follow-up, reimbursement analysis, or other PRMO functions within the assigned clinical area. This role monitors performance for staff handling appointment scheduling, registration, clinic check-in, and clinic collections. The revenue manager develops and utilizes reports to track financial and operational performance across the revenue cycle for the assigned clinical area.

This position serves as a liaison among PRMO, Operational Owners, and Maestro Care Clinical/Billing analysts to assist in the design, development, maintenance, training, and evaluation of assigned Maestro Care clinical and business systems supporting the revenue cycle. The role is primarily responsible for workflow design/re-design, collaboration with Maestro Care Build teams, testing, and validation of application functionality related to charge capture and billing.

Responsibilities

• Review and recommend changes/updates to department charge masters to maximize reimbursement.
• Review and recommend changes to department charge capture documents to ensure accurate and comprehensive billing in compliance with annual CPT/HCPCS and ICD-10 updates.
• Identify revenue cycle problems, research and analyze data to resolve issues, and implement solutions for improvement.
• Work with financial analysts, physicians, and administrative leadership to educate and train providers and staff about coding and revenue cycle issues.
• Act as a liaison to management and staff in designated clinical areas, PRMO, Duke University Health System (DUHS), Duke Health Integrated Practice, and third-party payers on revenue cycle activities.
• Continuously research, monitor, provide education, and implement payer regulations and guidelines related to revenue management.
• Coordinate revenue management orientation and educational activities for clinical personnel, including providers and staff.
• Develop and utilize management models to monitor productivity and quality of staff performance.
• Train, direct, and coordinate activities of assigned financial analysts or other employees.

Key Accountabilities

Revenue Management – 40% of Time

• Manage revenue cycle-related inquiries and serve as the Point Person/Service Line Resource (Liaison).
• Respond, research, and resolve revenue cycle-related inquiries pertaining to assigned Maestro Care applications.
• Manage assigned Service Now tickets and specialize in revenue cycle functions and Epic Systems applications.
• Serve as an Epic System knowledge source for charge capture functions, including charge capture, reconciliation, and corrections for procedures, medications, and supplies.
• Provide training on charge capture, reconciliation, and correction as needed.
• Resolve accounts in assigned Charge Router, Charge Review, Claim Edit, and Follow-Up Work Queues (WQs).
• Monitor and manage key performance indicators using standard and ad-hoc reports to track revenue cycle performance, including denial rates, avoidable write-offs, and full transaction write-offs.
• Review key metrics from scheduling to billing and collections in collaboration with PRMO Managers.
• Identify issues through ongoing monitoring of departmental metrics and routine meetings with operational managers.
• Monitor and manage reimbursement changes, including researching and educating on payer regulations and coordinating strategies through Bulletin Review and other resources.

Revenue Cycle Leadership – 30% of Time

• Facilitate revenue cycle collaboration and strategic planning activities, serving as the Duke Revenue Cycle Management & Integration lead for assigned areas.
• Participate in routine meetings with CFOs, AVPs, and Reimbursement Revenue Accounting to provide updates on current revenue cycle issues and priorities.
• Provide service-line-specific strategic planning and priorities to PRMO leadership through Revenue Manager Councils and Operations Meetings.
• Coordinate and chair revenue-oriented workgroups and meetings, sharing operational changes between PRMO, hospitals, and physician practices.
• Develop or participate in focused workgroups addressing registration, billing and collections, coding, charge capture, and Maestro Care applications.
• Manage communications among PRMO, hospitals, and physician practices, including organizing and leading workgroups to address revenue cycle performance issues.
• Arrange and coordinate revenue cycle training activities, including facilitating training on work/skills or career development topics (e.g., report writing, compliance/regulation interpretation).

Project Management – 20% of Time

• Manage and prioritize revenue and/or compliance requests, including revenue enhancement and compliance process improvement projects.
• Develop and manage action plans and timelines for projects such as Annual CPT Updates, new services, and locations.
• Investigate and manage revenue opportunities identified through reporting and analysis.
• Perform root cause analysis and develop creative solutions, including assembling cross-functional teams and maintaining comprehensive issue lists.
• Assist in developing re-engineered best-practice workflows and system optimizations to improve revenue cycle performance.
• Coordinate all Maestro Care revenue-cycle-related system setups/modifications necessary for new services, including:
  • Identifying and recruiting appropriate resources.
  • Working with Maestro Care trainers and administrative leadership to educate providers and staff about new services, specifically charge capture.
  • Collaborating with PRMO/Maestro Care billing teams to update charge router logic, charge review logic, and claim logic.
  • Validating revenue cycle functions post-go-live to confirm accurate billing and monitor denials/payments.
  • Notifying other PRMO operational areas of new services to determine required changes (e.g., provider enrollment, pre-registration).
• Example project subjects include:
  • Master File record creation/updates (e.g., billing provider record, department record, bill area record, charge codes).
  • New charge code creation and charge capture methodology validation/updates.
  • Updating charging preference lists, flowsheets, orderables, and linked chargeables.
  • Coordinating with PRMO coding staff to ensure awareness of new services/charge codes.

Epic Systems Advisory – 10% of Time

• Specialize and manage revenue cycle functions and Epic Systems applications.
• Investigate charge and claim information and navigate information systems.