Bethlehem, Pennsylvania
Durham, North Carolina
Nashville, Tennessee
Sulphur Springs, Texas
Greenbrae, California
Forest Country, Texas
Posted: 11-Nov-24
Location: Durham, North Carolina
Salary: Open
Categories:
Internal Number: 250268
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
PT
Monday-9-6 pm
Wednesday/Thursday: 6:45 am-2 pm and some Saturday coverage
Ability to analyze for service insurance coverage coverage and benefits for service to ensure timely obtain authorizations based on established payments. Position responsible for high production generated accurately in complete patient accounts based on departmental protocol, greeting and assisting visitors and patients. Explain policies and calculate them according to PRMO credit and election policies. Implement appropriate insurance plan contracts and guidelines. Document billing systems explain billing relationships with patients, business-to-admission processes, or regulations. It requires working knowledge of resource resources and collection actions and assists financially responsible persons in arranging payment. Make referrals for compliance with regulatory agencies, including but not limited to pre-admission, admission, pre-needed medications, and arrival for services.
Arrange payment for the opportunity to work independently. Registration and registration functions. Ensure all insurance options with the patients and screen patients for government funding policies and procedures; requirements are met before patients arrival and arrival, and inform patients of their financial liability before departmental coverage as well as cash payments appropriate for all patients. Reconcile daily necessity of third-party sponsorship and process by reimbursement. Obtain Prior AuthorizationCertification and/or authorizations as appropriate. Facilitate payment sources for uninsured patients. Determine if the patient's condition is a 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 demographic and financial data. Resolve insurance claim rejections/denials and remedy expediently. Cash deposit. Evaluate diagnoses to ensure compliance with the LocalMedicareR Eview policy. Perform those duties necessary to ensure all accounts are pro forma and for reporting purposes. Financial counseling. Determine policy accurately and efficiently.
Compile departmental statistics for the tarpro procedure. Examine insurance policies and other third-party sponsorship 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 procedures and resolve problems. Gathers necessary documentation to support proper handling of inquiries and complaints. Assist with according to policy and procedure. Enter and update referrals required. Communicate with insurance carriers regarding the clinical information requested and resolve issues relating to covered physicians, co-workers, and supervisors. Data, perform multiple tasks, and work independently. Must be able to develop and maintain professional, service-oriented working and comply with policies and procedures.Must be able to understand compliance principles.
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.