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Posted: 13-Feb-25
Location: Raleigh, North Carolina
Categories:
Internal Number: 254358
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.
Occ Summary
Accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, including but not limited to pre-admission, admis sion, pre-registration, and registration functions. Ensure all insurance requirements are met before patients' arrival and inform patients of their financial liability before arrival for services. Arrange payment options with nswiththe patients and screen patients for government funding sources.
Work Performed
Analyze insurance coverage and benefits TSO service to ensure timely reimbursement. Obtain all Prior authorization on certification and/or authorization 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 appro priate source of liability/payment. Admit, register, and pre-register pati ents accurate patient demographic and financial data. Resolve insurance claim rejections/denials and remedy expediently. Calculate and collect cash payments appropriately for all patients. Reconcile daily cash deposit. Evaluate diagnoses to ensure compliance with the LocalMedicare Review Policy. Perform those duties necessary to ensure all accounts are processed accurately and efficiently. Compile departmental statistics for budget and reporting purposes. Explain bills according to PRMO credit and collection policies. Implement appropriate collection actions and assist financially responsible persons in arranging payment. Make a referral for financial counseling. Determine the necessity of third-party sponsorship and process patients by policy and procedure. Examine insurance policies and other third-party sponsorship materials for sources of payment. I informed 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 theManufacturerDr urs and patients. Explain policies and procedures and resolve problems. g program as needed for medications. Greets and assists in gathering the necessary documentation to support the proper handling of inquiries nd complaints. Assist with departmental coverage as requested. Obtain authorizations based on insurance plan contracts and guidelines. Documenting the system according to policy and procedure. Enter and update referrals a required. Communicate with insurance carriers regarding 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 inaccordancewithestabli shed business processes or regulation. Requires working knowledge of compliance principles. The job allows the opportunity to work independently.
Minimum Qualifications
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 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 essential job functions that require specific physical and/or mental abilities. In addition, information and provisions for requests for reasonable accommodation will be provided to each hiring department.
Education
Work requires knowledge of basic grammar and mathematical principles normally required through high school education, with some post-secondary education preferred. Additional training or working knowledge of the edge 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 health care-related field and one year of experience working with the public. O r, a Bachelor's degree and one year of experience working with the public.
Degrees, Licensures, 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.
