PRMO Established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke Primary Care. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Dukeâ€™s reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.
***$5000.00 Commitment Bonus (2 installments over 12 months in 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 sign-on bonus.
Accurately complete patient accounts based on action policies. Implement appropriate collection actions and assist financially responsible persons in arranging payment. Make referrals for financial 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 financial counseling. Determine the necessity of third-party sponsorship and process protocol, policies, and procedures, as well as compliance with regulatory agencies, including but not limited to pre-admission, admission, and registration functions. Ensure all insurance requirements are met before the patient's arrival, and inform patients of their financial viability before their arrival for services. Arrange payment options with the patients and screen patients for government funding sources.
Analyze insurance coverage and benefits for service to ensure timely reimbursement. Obtain all prior authorization certifications 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 the insurance claim rejections or denials and remedy them expediently. Calculate and collect CAS payments appropriately for all patients. Reconcile the daily cash deposit.
Evaluate diagnoses to ensure compliance with the Local Medical Review Policy. Perform those duties necessary to ensure all accounts are processed accurately and efficiently. Compile departmental statistics to inform the attending physician 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. Greet and provide 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 billing system according to policy and procedure. Enter and update referrals as required. Communicate with insurance carriers regarding the clinical formation requested 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.
Position responsible for high production generated accurately by established business processes or regulations. Requires working knowledge of compliance principles. The job allows the opportunity to work independently.
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
Two years of experience working in hospital service access, clinical service access, the physician office 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
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.
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 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.