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Accurately complete patient accounts based on de partmental protocol,policies and procedures, and compliance with regulat ory agencies, toinclude but not limited to pre-admission, admission, pre -registrationand registration functions. Ensure all insurance requiremen ts are metprior to patients' arrival and inform patients of their financ ialliability prior to arrival for services. Arrange payment options with the patients and screens patients for government funding sources.
Analyze insurance coverage and benefits f or service to ensure timelyreimbursement. Obtain all Prior Authorization Certification and/orauthorizations as appropriate. Facilitate payment s ources for uninsuredpatients. Determine if patient's condition is the re sult of an accidentand perform complete research to determine the approp riate source ofliability/payment. Admit, register and pre-register patie nts withaccurate patient demographic and financial data. Resolve insuran ceclaim rejections/denials and remedy expediently.Calculate andcollect c ash payments appropriately for all patients. Reconcile dailycash deposit . Evaluate diagnoses to ensure compliance with the LocalMedicare Review Policy. Perform those duties necessary to ensure allaccounts are process ed accurately and efficiently. Compile departmentalstatistics for budget ary and reporting purposes.Explain billsaccording to PRMO credit and col lection policies. Implement appropriatecollection actions and assist fin ancially responsible persons inarranging payment. Make referral for fina ncial counseling. Determinenecessity of third party sponsorship and proc ess patients in accordancewith policy and procedure. Examine insurance p olicies and other thirdparty sponsorship materials for sources of paymen t. Inform attendingphysician of patient financial hardship. Complete the managed carewaiver form for patients considered out of network and rece ivingservices at a reduced benefit level. Update the billing system tore flect the insurance status of the patient. Refer patients to theManufact urer Drug program as needed for medications. Greet andprovides assistanc e to visitors and patients. Explain policies andprocedures, and resolves problems. Gathers necessary documentation tosupport proper handling of inquiries and complaints. Assist withdepartmental coverage as requested. Obtain authorizations basedon insurance plan contracts and guidelines. D ocument billing systemaccording to policy and procedure. Enter and updat e referrals asrequired. Communicate with insurance carriers regarding cl inicalinformation requested and to resolve issues relating to coverage a ndpayment.
Excelle nt communication skills, oral and written. Ability to analyzedata, perfo rm multiple tasks and work independently. Must be able todevelop and mai ntain professional, service-oriented workingrelationships with patients, physicians, co-workers and supervisors.Must be able to understand and c omply with policies and procedures.
Position responsible for high production generated accurately ina ccordance with established business processes or regulation. Requireswor king knowledge of compliance principles. Job allows the opportunityto wo rk 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, 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, 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.