Remote Cold Case Investigator Jobs in Raleigh, NC

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.
Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Business Process Consultant who will embrace our mission of Advancing Health Together.
The Business Process Consultant (BPC) serves as the primary analytical resource supporting all revenue cycle processes, systems and workflow. The BPC is a subject matter expert in Epic (Maestro Care), data analytics, payer reimbursement and demonstrates a broad spectrum of operational expertise across many areas of the Revenue Cycle. The BPC supports the Revenue Cycle departments and operational leaders within the Patient Revenue Management Organization (PRMO) by identifying opportunities to improve operational efficiency and performance. The BPC has a system focus through monitoring of dashboards and key metrics to pro-actively identify, analyze, and trend issues. The BPC strategically supports operations by identifying opportunities to improve workflow and effectiveness through projects and innovative solutions to enhance automation, quality and efficiency through enhancement requests, report writing, analysis and business case development and data validation.
Work Performed
Identification and Analysis of Financial Opportunities:

• Identify existing and future revenue cycle-based improvement opportunities
• Lead PRMO discussions, evaluations, selections and prioritization of improvement opportunities, including the development of an ROI analysis to better understand and determine potential impact on overall PRMO performance
• Work closely with PRMO leadership to understand operational goals and challenges to identify opportunities for enhancements
• Perform and prepare regular root cause analysis of performance of the revenue cycle function to identify areas of opportunity utilizing various data systems including Slicer Dicer and Tableau
• Responsible for various standard, recurring reporting functions to support revenue cycle operational business needs
• Assists revenue cycle senior leaders in working closely with organizational stakeholders to improve financial performance based on analytic findings
• Monitor key performance indicators for internal and external parties
• Cultivates internal relationships to assist in understanding department workflows
• Provides analytics for and supports special projects as needed (e.g. new payer policy financial impact)

• Support investigation into claims/denials patterns, payer policy changes, collection rate shifts, avoidable write-off's, and payer mix evaluation to optimize payer performance.

• Develop analytical models that are well-documented containing advanced formulas and functions that are used to evaluate historical trends, forecast future expectations, or draw conclusions
• Point person for month-end Revenue Cycle Net Revenue Review

Revenue Cycle Strategic Initiatives and Project Management:

• Create, design, lead, and implement strategies that will reduce AR, improve aging AR, improve net collection rate, eliminate waste through automation or optimization of workflows, reduce denials, and reduce avoidable write -offs, for all areas of the Revenue Cycle
• Develop, maintain, and enhance knowledge of Revenue Cycle systems and third-party vendors to support recommendations for optimal workflows.
• Leverage technology and best practices to recommend process improvements

Collaboration:

• Effectively communicate trends to influence all levels of leadership for process improvements
• Partner with leaders and teams to review and establish improvement opportunities
• Perform project management duties to align multi-disciplinary groups across the revenue cycle and clinical departments, corporate finance, DHTS, and hospital service line leadership
• Communicate and track progress of identified issues and action items
• Partner with Operations Improvement on outstanding optimization and automation projects

Other:

• Promote PRMO strategic vision, mission, and purpose while emphasizing teamwork and results.
• Create and foster a department culture that provides a satisfying and enriching environment in which staff can be developed and retained.
• Interact with and provide timely verbal/written responses to all stakeholders (patients, providers, payors, and departmental personnel).
• Acknowledge management requests and emails in a professional, timely manner.
• Attend meetings and participate in Work Culture initiatives, committees or workgroups, as assigned.
• Accomplish all tasks as assigned.

Minimum Qualifications
Education
Bachelor's degree required. Master's degree preferred.
Experience
Minimum of 7 years work experience. Extensive knowledge of Revenue Cycle analytical tools, business intelligence tools and statistical packages. Proven experience with Revenue Cycle workflows to include but not limited to overall claims processing spanning the life cycle of the revenue cycle, denials management, insurance follow up, and net collection rate impacts and calculations.
Experience can be supplemented with Master's degree with a Masters being equivalent to two years of experience
Degrees, Licensures, Certifications
None
Knowledge, Skills and Abilities
Knowledge of:

• Epic System (Revenue Cycle Applications)
• Revenue Cycle operations

Ability to:

• Understand revenue cycle operational performance goals/metrics
• Strong analytical skills
• Perform root cause analysis with accuracy
• Identify and implement optimization opportunities within Epic
• Investigate and analyze information and provide recommend solutions for identified issues
• Develop, implement and oversee project teams comprised of IT and operational resources
• Communicate effectively, both orally and in writing
• Demonstrate strong interpersonal and communication skills
• Work effectively with a wide range of constituencies in a diverse community
• Foster a positive work environment
• Multi-task

Systems

• Epic
• MS Office Applications (Word, Excel, Visio, PowerPoint)
• Kodiak RCA

Duke is an 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 (including pregnancy and pregnancy related conditions), sexual orientation or military 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 essential job 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.