Durham, North Carolina
Fort Lauderdale, Florida
Riverside, California
Raleigh, North Carolina
Posted: 03-Jan-25
Location: Durham, North Carolina
Categories:
Internal Number: 252817
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.
Working Job Description: Friday, Saturday, and Sunday 12-hour shift Weekend Options: 6:00 am-6:30 p.m.
Duties and responsibilities:
Clinical Quality: 50%? Identifies, admits, schedules, registers, and pre-registers patients with accurate patient demographic and financial data. Meets or exceeds data quality goals.? Explains all required registration and billing forms and obtains signatures where applicable. ? Verifies insurance benefits using our electronic insurance verification system and/or contacts payors via website or phone. Assign the correct coverage to the patient's account. ? Completes Medicare Secondary Payer Questionnaire ( MSPQ).? Collects point-of-service payments. Meets or exceeds collection goals. ? Creates estimates for upcoming services when applicable. ? Arrange payment plans and offer financial assistance when applicable.? Reconciles daily cash deposits. ? Performs duties necessary to ensure all accounts are processed accurately and efficiently.
Customer Service: 20%? Greets and assists our patients and visitors. ? Exhibits the DUHS values (Excellence, Safety, Integrity, Diversity, and Teamwork) at all times while on duty. ? Explains policies and procedures and resolves problems. Gathers necessary documentation to support the proper handling of inquiries and complaints. ? Explains bills according to PRMO financial assistance policies.
Finance: 10% ? Resolves claim edits. ? Research denials and provide feedback. ? Completes a non-covered waiver form for patients considered out of network and receiving. services at a reduced benefit level. ? Completes waiver for non-authorized services. ? Obtain authorizations based on insurance plan contracts and guidelines. ? Documents the billing system according to policy and procedure. ? Enters and updates referrals as required.
Work Culture: 20% ? Assists with departmental coverage as requested. ? Attends monthly staff meetings. ? Attend all required training and seek continuous learning opportunities.? Maintains compliance with safety and training requirements.
? Review PRMO policies and procedures on the PRMO website to maintain compliance with approved policies and procedures. ? Contributes to an environment of collaboration and teamwork. Required 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 in related business will be considered. Experience: Two years experience working in hospital service access, clinical service access, physician offices, billing, and collaborations, 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 are required. Degrees, licenses, and/or certifications: None required Knowledge, skills, and abilities: Excellent communication skills, oral and in writing. 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. Distinguishing Characteristics of this Level: This position is deemed "essential". Essential staff is expected to report to work during inclement weather. This position is responsible for high productivity, generated accurately by established business processes or regulatory requirements. Bedside regularization is performed in the emergency department and the inpatient units.
This position requires long periods of walking, standing, and sitting. This position requires working knowledge of compliance principles. A job requires the ability to work independently. This job description intends to provide a representative level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in the description. : Responsibilities that will be required of positions given this title declaration of the total of the specific duties and responsibilities of the level of the types of duties shall not be construed as Knowledge, skills, and abilities: Identify, admit, schedule, register, and pre-register patients with accurate patient demographic and financial data. Resolve insurance claim rejections/denials and remedy expediently. Verify insurance benefits. Provide insurance benefit interpretation and counseling. Calculate and collect payments appropriately for all patients. Assist financially responsible persons in arranging payment. Reconcile the daily cash deposit. Meet collection and data quality goals. Perform duties necessary to ensure all accounts are processed accurately and efficiently. Explain all required regulations and billing forms and obtain signatures where applicable. Explanation in bills according to PRMO financial assistance policies. Make referrals for financial counseling when applicable. Complete a managed care waiver for RM 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. Greet and assist our patients and visitors. Exhibit the DUHS values (Excellence, Safety, Integrity, Diversity, and Teamwork) at all times while on duty.
Explain policies and procedures and resolve problems. Gather necessary documentation to support the proper handling of inquiries and complaints. Assist with departmental coverage as Obta in authorizations based on insurance plan contracts and guidelines. Document the billing system according to policy and procedure. Enter and update the referrals as required. Communicate with insurance carriers regarding the critical information requested and resolve issues relating to coverage and payment. 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 in late business will be considered. Two years of experience working in hospital service access, clinical service access, physician offices, billing, and collections, or an Associate's degree in a healthcare-related field with one year of experience working with the public, or a Bachelor's degree with one year of experience working with the public are required. #Degrees, License, and/or Certification: None required
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.