Patient Account Analyst - Payor Relations

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Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is the 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 for Duke Health.

REMOTE POSITION: Monday - Friday

Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Patient Account Analyst who will embrace our mission of Advancing Health Together.

General Description of the Job Class:

The Patient Account Analyst is responsible for all payer related issues and external relations across the entire revenue cycle for hospital and professional services. The analyst will work collaboratively with all payers (governmental and non-governmental) to facilitate the dissemination of payer policies and procedures that impact payment, as well as internal departments, serving as a liaison between the health system and payers to resolve complicated issues. The analyst will also work collaboratively with the denial management team analyzing third-party denial trends for hospital and professional services, researching root causes of claim denials, and working with PRMO Senior Leadership and Operational Management to reduce denial volumes to improve revenue cycle performance by enhancing revenue and reducing costs.

Duties and Responsibilities of this Level:

Primary Liaison between PRMO and Payor Mix (85%):

•             Develop and maintain strong working relationships with DUHS and DHIP governmental and non-governmental payers.

•             Engage payers when necessary to reach resolution on unpaid accounts.

•             Work closely with DUHS and DHIP contracting management to ensure that regulatory updates are effectively implemented and share feedback provided from PRMO operational areas to assist with billing and collections.

•             Assist with managing the relationship with the onsite Blue Cross BlueShield staff.

•             Assist contracting with maintenance and relevant updates to our managed care contract matrix on a revolving monthly basis

•             Work closely with the North Carolina Hospital Association/NC Division of Health and Human Services to keep abreast of operational and legislative issues that may impact the organization.

•             Conduct system wide in-service meetings, bulletin meetings, and distribute relevant payer newsletters to ensure that all regulatory and administrative changes are effectively communicated and implemented.

•             Provide education and feedback to clinical and PRMO operational leadership as necessary.

•             Review payer websites and ensure that issues which impact operations are tracked and assigned in the bulletin review database or any other solution that would facilitate information dissemination.

•             Compile, develop and distribute the monthly payer newsletter to highlight changes that would impact revenue cycle operations.

•             Represent DUHS and DHIP by attending all relevant payor-specific engagements above and beyond our internal engagement framework (JOC platform and working file discussions)

•             Work collaboratively with the denial management team to understand the weekly and monthly denial reports across all systems that summarize denial performance and trends, with breakdowns by entity, pay or rejection/denial-type.

•             Coordinate and conduct detailed research to identify root causes of denials, including a review of impacted accounts/invoices, review of payor reimbursement documentation and online policy information as well as engaging with operational billing & collections stakeholders as appropriate.

•             Identify process improvements to reduce denial volumes, including staff education/training, operational workflow modifications, system enhancements/edits, payor policy changes and relevant stakeholders to implement improvements.

•             Act as a technical resource to PRMO operational management and staff on the appropriate interpretation of rejection/denial codes and actions required for the effective resolution and follow up of those codes.

•             Communicate directly with third-party payors regarding operational/workflow issues (i.e. user, system, payor) related to impacted rejection and/or denial subsets.

Technical Expertise (15%)

•             Develop and maintain documentation summarizing workflow processes and operating policy & procedure for all functions relating to payor mix

•             Develop and maintain a working and effective knowledge of all functions performed by team

•             Develop and maintain a working knowledge of relevant payor billing requirements and reimbursement regulations

•             Develop and maintain a working knowledge of all core systems (Maestro Care) and ancillary systems (Availity, Hyland, payor-specific portals, etc.) utilized by team

•             Develop and maintain complete understanding of all operational policies and procedures relevant to team

•             Develop and maintain working and proficient knowledge of personal computer software required for fulfilling management responsibilities, including Outlook, Excel reporting, Word processing, Visio flowchart, PowerPoint presentation, ServiceNow Change Controls, I-forms, and API/PTO

Required Qualifications of this Level:

Education and Training:

 Bachelor’s degree in business, healthcare administration, accounting, finance or a related field is required.

Experience & Skills:

Minimum of four years of applicable experience. Previous experience successfully managing complex projects involving multiple stakeholders with a consistent track record of delivering on time, or high-quality results preferred.

A master’s degree in a related field can substitute two years of experience on a 1:1 basis.