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
Accurately complete patient accounts by following departmental protocol, policies and procedures, and ensure compliance with regulatory patients and screening patients for government funding sources.
Work Performed
Analyze insurance coverage and benefit its financial agencies, including but not limited to pre-admission, admission, pre-registration, and registration functions. Ensure all insurance requirements are met prior to arrival for services. Arrange payment options prior to patients' arrival and inform patients of their financial service to ensure timelyreimbursement. Obtain all Prior authorizations onCertification certification and/or authorizations as appropriate. Facilitate payment sources for uninsuredpatients. Determine if the patient's condition is the result of an accident and perform complete research to determine the appropriate source of liability or payment. Admit, register and pre-register patients with accurate patient demographic and financial data. Resolve insuranceclaim rejections/denials and remedy expediently.Calculate andcollect c-ash ashpayments appropriately for all patients. Reconcile the daily cash deposit. Evaluate diagnoses to ensure compliance with the Local Medical Review Po licy. Perform those duties necessary to ensure allaccounts are processed accurately and efficiently.
Compile departmentalstatistics for budgetary and reporting purposes.Explain billsaccording to PRMO credit and collect ion policies. Implement appropriatecollection actions and assist financi ally responsible persons inarranging payment. Make referral for financial counseling. Determine the necessity of third-party sponsorship and process p participants in accordancewith policy and procedure. Examine insurance policies and other third-party sponsorshipmaterials for sources of payment.Inform the attending physician of the patient's financial hardship. Complete the Managed Caregiver form for patients considered out of network and receiving vices at a reduced benefit level. Update the billing system to reflect the insurance status of the patient. Refer patients to theManufacturer manufacturer, distributors, and patients. Explain policies and procedures and resolve problems as needed for medications. Greet and provide assistance to visitors.Provide the necessary documentation to support the proper handling of inquiries and complaints. Assist with departmental coverage as requested.Obtain authorizations basedon insurance plan contracts and guidelines. Documenting systems according to policy and procedure. Enter and update referrals as required. Communicate with insurance carriers regarding clinicalinformation information requested and to resolve issues relating to coverage andpayment.
Knowledge, Skills and Abilities
Excellent communication skil ls, oral and written. Ability to analyzedata, perform multiple tasks, and work independently. Must be able todevelop and maintain professional, se rvice-oriented workingrelationships with patients, physicians, co-workers, and supervisors.Must be able to understand and comply with policies and procedures.
Level Characteristics
Position responsibility for high production generated accurately inaccordance with established business processes or regulations. It requires working knowledge of compliance principles. The job provides the opportunityto work independently.
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.