Director, Preservice Verification, PRMO

Director of Preservice Verification, PRMO at Duke Health leads the Preservice Verification department across the system, directing strategy to verify insurance eligibility, authorization, and medical necessity prior to service, and overseeing denials/appeals processing. Responsibilities include planning and coordinating department activities, improving revenue cycle performance and payor requirements compliance, formulating policies and procedures, monitoring denials and write-offs, implementing strategies to reduce denials, managing internal controls, ensuring workflow adherence, serving as an internal consultant on eligibility/authorization/medical necessity, directing outsourcing/vendor relationships, guiding technology implementations affecting department operations, and contributing to PRMO leadership strategy and balanced scorecard goals. Required qualifications include a Bachelor's degree, 8 years of progressive healthcare administration/clinical experience with at least 5 years in people or project management, strong leadership and communication skills, knowledge of payor coverage requirements, payor regulations, and experience with clinical providers; Epic experience is preferred. The role emphasizes leadership within Duke Health’s PRMO and a commitment to diversity, inclusion, and a patient-centered, compliant revenue cycle function.