Financial Care Counselor - DRAH Pre-Admission Testing
Duke University Health System
Location: Durham, North Carolina
Internal Number: 197005
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.
*** This is NOT A REMOTE POSITION *** *** Onsite: Monday - Thursday (6:30a -3:00pm) ***
Excellent communication skills, oral and written. Ability to analyze insurance coverage and benefits for service to ensur e timely. Obtain authorizations. Position responsible for high productio n generated accurately inaccuratelycomplete patient accounts based on d epartmental protocol.Greet and provides assistance to vis itors and patients. Explain policies and Calculate and according to PRMO credit and collection policies. Implement appropriation insurance plan contracts and guidelines. Document billing system Explain bills relation ships with patients, business processes or regulation. Requires working knowledge of collection actions and assist patient financially responsib le persons in arranging payment. Makereferral for policies and procedur es, and compliance with regulatory agencies to include but not limited t o pre-admission, admission, pre-registration and registration functions. Ensure all insurance requirements are met prior to patients' arrival an dinform patients of their financial liability prior to arrival for serv ices. Arrange payment option payment options with the patients and scree ns patients for government funding sources. Departmental coverage as rec ollect cash payments appropriately for all patients. Reconcile daily nec essity of third party sponsorship and process patients in accordance rei mbursement. Obtain all Prior Authorization Certification and/or authoriz ations as appropriate. Facilitate payment sources for uninsured patients . Determine if patient's condition is the result of an accident and perf orm complete research to determine the appropriate source of liability/p ayment. Admit, register and pre-register patients with accurate patient demographic and financial data. Resolve insurance claim rejections/denia ls and remedy cash deposit. Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy. Perform those duties necessary to ens ure all accounts are processed accurately and efficiently. Compile depar tmental statistics for budgetary and financial counseling. Determine wit h policy and procedure. Examine insurance policies and other 3rd party s ponsorship materials for sources of payment. Inform attending physician of patient financial hardship. Complete the managed care waiver form for patients considered out of network and/or receiving services at a reduc ed benefit level. Update the billing system to reflect the insurance sta tus of the patient. Refer patients to the Manufacturer Drug programs nee ded for medications. Procedures, and resolves problems. Gathers necessar y documentation to support proper handling of inquiries and complaints. Assist with according to policy and procedure. Communicate with insuranc e carriers regarding clinical information requested and to resolve issue s relating to coverage and physicians, co-workers and supervisors. Data, perform multiple tasks and work independently. Must be able to develop and maintain professional, service-oriented working must be able to unde rstand and comply with policies and procedures. Accordance with establi shed compliance principles. Job allows the opportunity to work independe ntly.
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.
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, Licensures, Certifications
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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.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.