Los Angeles, California
Stony Brook, New York
Hershey, Pennsylvania
Posted: 18-Aug-24
Location: Raleigh, North Carolina
Salary: Open
Internal Number: 248890
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.
DRAH ED
Work Hours
Monday-Thursday 5:30 pm-4:00 am
Duke University Health System's Patient Review Management Office (PRMO) seeks to hire a financial counselor who will embrace our mission of advancing health together.
Accurately complete patient accounts based on 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 liability prior to their arrival for services. Arrange payment options with the patients and screen them for government funding sources.
Work performed
- Analyze insurance coverage and benefi ts for service to ensure timely.
- Obtain authorizations based on payments made under insurance plan contracts and guidelines.
- Document billing system.
- Explain bills provides assistance to visitors and patients.
- Explain policies and departmental coverage as requested.
- Implement appropriate cash payments appropriately for calculation and according to PRMO credit and collection policies.
- Reconcile the daily necessity of third-party sponsorship and process patients in accordance with reimbursement.
- Obtain all prior authorization certifications and/or authorizations as appropriate.
- Facilitate payment sources 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 demographics and financial data.
- Resolve insurance claim rejections and denials and remedy them expediently.
- Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy.
- Perform those duties necessary to ensure all accounts are processed accurately and efficiently.
- Compile departmental statistics for budgetary and reporting purposes.
- Collection actions and assist financially responsible persons in arranging payment.
- Make a referral for financial counseling.
- Determine the policy and procedure.
- Examine insurance policies and other third-party sponsor materials for sources of payment.
- Inform the attending physician of the patient's financial hardship.
- Complete the managed care waiver 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 Manufacturer Drug Program as needed for medications.
- establishes procedures and resolves problems.
- Gathers the necessary documentation to support the proper handling of inquiries and complaints.
- Assist with according to policy and procedure.
- Enter and update referrals as required.
- Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage
Know ledge, Skills and Abilities
- Excellent communication skills, oral and written.
- Ability to analyze relati onships with patients, physicians, co-workers and supervisors. data, performmultiple tasks and work independently.
- Must be able to d evelop and maintain professional, service-oriented working,
- 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.
- 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 a postsecondary education preferred. Additional training or working knowledge of related businesses.
Experience
Two years of experience working in hospital service access, clinical alservice access, 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
None required
Job Code: 00004500 FINANCIAL CARE COUNSELOR
Job Level: C1
Duke is an affirmative action/equal opportunity employer committed to providing employment opportunities without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic origin, national origin, race, religion, sex, sexual orientation, or gender 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 is present. 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 commu nity have a responsibility to uphold thesevalues.
Essential Physical Job Functions: Certain jobs at DukeUniversity and Duke University Health System may include essential jobfunctions that requir e specific physical and/or mental abilities. Additional information and plans for requests for reasonable accommodation will be provided by the HR department.
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.
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.