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.
Occ Summary
Correctly complete patient accounts based on policies. Implement appropriate collection actions and assist financially responsible persons in arranging payment. Make referrals for finance and reporting purposes. Explain bills according to PRMO credit and co-pay patients by policy and procedure. Examine insurance policies and other third-party sponsorship materials for sources of payment counseling. Determine the necessity of third-party sponsorship and process departmental protocol, policies and procedures, and compliance with regulatory agencies, including but not limited to pre-admission, admission pre-registration, and registration functions. Ensure all insurance requirements are met before patients' arrival and inform patients of their financial viability before arrival for services. Arrange payment options with the patients and screen patients for government funding sources.
Work Performed
Analyze insurance coverage and benefits for service to ensure timely reimbursement. Obtain all Prior Authorization Certification and/or authorizations as appropriate. Facilitate payment services for uninsured patients. Determine if the patient's condition is the result of an accident and perform complete research to determine the appropriate source of liability/payment. Admit, register, and pre-register patients with accurate patient demographic and financial data. Resolve insurance claims/rejections/denials and remedy them expediently. Calculate and collect cash payments appropriately for all patients. Reconcile the daily cash deposit. Evaluate diagnoses to ensure compliance with the LocalMedicare Review PO license. Perform those duties necessary to ensure all accounts are processed accurately and efficiently. Compile departmental statistics for budgetary information to inform attending physicians of patient financial hardship. Complete the man-aged caregiver form for patients considered out of network and receiving services at a reduced benefit level. Update the billing system to reflect the insurance status of the patient. Refer patients to the manufacturers and patients. Explain policies and procedures and resolve problems Drug program as needed for medications. Greets and assists Ms. Gathers with the necessary documentation to support the proper handling of inquiries and complaints. Assist with departmental coverage as requested. Obtain authorizations based on insurance plan contracts and guidelines. Document billing system according to policy and procedure. Enter and update referral referrals as required. Communicate with insurance carriers regarding clinical formation requests and resolve issues relating to coverage and payments.
Knowledge, Skills, and Abilities
Excellent communication skills, oral and written. Ability to analyze data, perform multiple tasks, and work independently. Must be able to develop and maintain professional, service-oriented working relationships with patients, physicians, co-workers, and supervisors.Must be able to understand and comply with policies and procedures.
Level Characteristics
Posit ion responsible for high production generated accurately in accordance wit accordance with established business processes or regulations. Requires working knowledg e of compliance principles. Job allows the opportunity to work independen tly.
Minimum Qualifications
Education
Work requires knowledge of basic grammar and mathematical principles normally required through a high school education, with some postsecondary education preferred. Additional training or working knowledge of related business.
Experience
Two years experience working in hospital service access, clinical service access, physician office, or billing and collections. Or, an Associate's degree in a healthcare-related field and one year of experience working with the public. Or, a Bachelor's degree and one year of experience working with the public.
Degrees, licenses, and certifications
None required
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.
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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.