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Posted: 22-Jan-25
Location: Raleigh, North Carolina
Internal Number: 253330
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.
Duke Raleigh Hospital location:
Pain Clinic MOB7
Availability: 6:30 am to 3:00 pm Monday through Friday
Work Performed Excellent communication skills, oral and written. Ability to analyze insurance coverage and benefits for service to ensure timely Obtain authorizations-based accordance with established payment. Position responsible for high production generated accurately in Accurately complete patient accounts based on departmental protocol, Greet and assist visitors and patients. Explain policies and calculate and adhere to PRMO credit and collection policies. Implement appropriate insurance plan contracts and guidelines. Document billing system Explain bill coverage and medications. Policies and procedures, considered out of network and receiving services at a reduced benefit and in compliance with regulatory agencies, include but are not limited to pre-admission, admission, 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 the patients and screen patients for government funding sources. Departmental coverage is to collect cash payments appropriately for all patients. Reconcile the daily necessity of third-party sponsorship and process patients by 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-regis ter patients with accurate patient demographic and financial data. Resolve insurance claim rejections/denials and remedy expediently. Cash deposit it. Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy. Perform those duties necessary to ensure all accounts for budgetary and reporting purposes. Collection actions and assist financial progress accurately and efficiently. Compile departmental statistically responsible persons in arranging payment. Make a referral for financial counseling. Determine with policy and procedure.
Examine insurance policies as another third-party sponsorship material for sources of payment. Info RM attending physician of patient financial hardship. Complete the managed care waiver form for the patient's level. Update the billing system to reflect the insurance status of the patient. Refer patients to the manufactured drug program as needed for procedures and resolve problems. There is necessary documentation to support the proper handling of inquiries and complaints. Assist with according to policy and procedure. Enter and update the referrals as required. Communicate with insurance carriers regarding clinical information requested and resolve issues relating to relationships with patients, 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 understand and comply with policies and procedures. Business processes or regulations. Requires working knowledge of compliance principles. The job allows 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 business.
Experience
Two years experience working in hospital service access, clinical service access, the physician's 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.
