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.
MON-THU 330 p.m.–2 a.m. (Work schedule)
*** DUHS Commitment Bonus Program: $5000.00 (paid in 2 installments over 12 months - 6-month increments) ***
* Only new hires who have not worked for Duke University in the past 12 months (at the time of offer) are eligible to receive the commitment bonus.
Occ Summary
Accurately complete patient accounts based on Licy. Perform those duties necessary to ensure all accounts are processed. Evaluate diagnoses to ensure compliance with the Local Medical Review 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 prior to patients' arrival, and inform patients of their financial viability prior to their arrival for services. Arrange payment options with the patients and screen patients for government funding sources.
Work Performed
Analyze insurance coverage and benefits for the service to ensure timely reimbursement. Obtain all prior authorization certificates 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 or payment. Admit, register, and pre-register patients with accurate patient demographic and financial data. Resolve insurance claim rejections and denials and remedy them expediently. Calculate and collect case payments appropriately for all patients. Reconcile the daily cash deposit accurately and efficiently. Compile departmental statistics for budgetary and reporting purposes. Explain bills according to PRMO credit and collect on policies. Implement appropriate collection actions and assist financially responsible persons in arranging payment. Make a referral for financial counseling. Determination of the necessity of third-party sponsorship and processes in accordance with policy and procedure. Examine insurance policies and other third-party sponsorship materials for sources of payment. Inform attending physicians of the patient's financial hardship. Complete the Managed 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 with the programs needed for medications. Greet and assist visitors.
Gathers 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 the system according to policy and procedure. Enter and update referrals as required. Communicate with insurance carriers regarding the clinical information requested and resolve issues relating to coverage and payment.
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
Position responsible for high production generated accurately in accordance with established business processes or regulations. It requires working knowledge of compliance principles. The job provides the opportunity to 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 businesses.
Experience
Two years of experience working in hospital service access, clinical service access, the physician's 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.