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.
Occupational Summary
- Accurately complete patient accounts based on departmental protocol, policies and procedures and comply with regulatory agencies, including but not limited to pre-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 patients for government funding sources.
Work Performed
- Analyze insurance coverage and benefits for service to ensure timely .
- Obtain authorizations based on payments based on insurance plan contracts and guidelines.
- Document billing system.
- Explain bills and provide assistance to visitors and patients.
- Explain policies and departmental coverage as requested.
- Calculate according to PRMO credit and collection policies.
- Implement appropriate cash payments for all patients.
- 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 a thorough research to determine the appropriate source of liability/payment.
- Admit, register and pre-register patients with accurate patient demographic and financial data.
- Resolve insurance claim rejections/denials and remedy them promptly.
- Evaluate diagnoses to ensure compliance with the Local Mcessary and 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 sponsorship materials for sources of payment.
- Information from attending physicians about patient 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's drug program as needed for medications.
- Greets, follows procedures and resolves problems.
- provides the necessary documentation to support the proper handling of inquiries and complaints.
- Assist according to policy and procedure.
- Enter and update references as required.
- Communicatewith insurance carriers regarding the requested clinical information and to resolve issues related to coverage
Knowledge,Skills and Abilities - Excellent communication skills, oral and written.
- Ability to analyze relationships with patients, physicians, co-workers and supervisors. Perform multiple tasks and work independently.
- Must be able to develop and maintain professional, service-oriented work,
- Must be able to understand and comply with policies and procedures.
Level Characteristics - The position responsible for high production is rated accurately in accordance with established business processes or regulations.
Requires working knowledge of compliance principles. A job provides the opportunity to work independently.
Accurately complete patient accounts based on departmental protocol, policies and procedures and compliance with regulatory agencies, including but not limited to pre-admission, admission, 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 patients for government funding sources.
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-wo rkers 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 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.