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Posted: 08-Jan-25
Location: Durham, North Carolina
Categories:
Internal Number: 252435
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 HomeCare & Hospice
Pursue your passion for caring with Duke HomeCare & Hospice, which offers hospice, home health, and infusion services across the region, as well as serves as the home forthe Duke Caregiver Support Program. Team members work closely with a patient's physician to provide comprehensive, individualized care in the comfort of their home or at our inpatient hospice facility in Durham, NC.
Summary
Responsible for performing ensuring Medical record and patient data is accurate and complete and in compliance with DHCH policies, and state, federal and regulatory standards. Ensures insurance requirements are met related to visit/authorization and work queue processing. Contributes to DHCH performance improvement culture by identifying opportunities for improvements and participates on PI measurement activities. This is position has high customer service with our clinicians and physicians by phone and requires excellent customer service skills. The PSR position can also assist with accounts payable activities. This position must be able to work independently to process complex patient claim/authorization issues by therapy and payer specifications to assure accurate and timely claim submission.
Position Responsibilities
Ensures confidentiality of patient information through HIPAA Compliance.
Maintains knowledge base on changes to reimbursement, including but not limited to specific managed care contracts, Medicare/Medicaid guidelines, and third party insurance payers.
Initiates appropriately timed correspondence and telephone contact to clarify and explain account or coverage situation with patients or guarantors, employers, insurance companies, and sponsoring agencies; obtains cooperation toward settlement of account.
Maintains patient financial files as required by supervisor.
Adhere to all regulatory standards for medical records, making sure all information for medical records are kept confidential and stored properly.
Discharged patient records moved to discharged filing space on a monthly basis.
Records older than current year minus 1 are archived and sent off site on a quarterly basis.
Keeps current with new system functionality.
Reviews release notes for software changes related to the employee's work area.
Works with manager /vendor to identify issues related to system upgrades.
Works with supervisor/vendor to identify software related issues - ongoing
Utilization and identification of technology to improve documentation and communication.
Maintains accountability for the prompt processing of claims including billing, preparing for mailing or electronic transmitting, and the collection of those claims, for a set group of accounts assigned.
Obtains and follows up on all documentation needed in order to bill.
Contributes to DHCH performance improvement culture by identifying opportunities for improvements, participates on PI measurement activities( audits) and meets expected PI expectations, (compliance with documentation requirements.
Submits appropriate documentation for adjustments, write-offs or bad debt to the appropriate Supervisor of Billing & Reimbursement.
Employee provides cross training to other team members. Cross training is considered complete when employees are able to provide basic coverage assistance if needed.
Performs special projects as assigned and other duties as requested.
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. Understanding of medical terminology, coding, third-party benefits, government payer regulations and EPIC experience. Must be computer literate. Excel experience is a plus.
Experience
Two to five years experience working in hospital access, physician office or billing and collections or an equivalent combination of relevant education and /or experience. Preferred experience in billing, reimbursement and/or medical office administration, preferably in a health care setting. A general knowledge related to government payer regulations and third party payer guidelines is helpful. EPIC experience is a plus.
Skills, Knowledge, Abilities
The individual must be detail-oriented and possess time management, analytical, and organizational skills. The individual must be able to work in a fast-paced environment and meet deadlines. This person must be able to work independently and have great focus. The individual must be accurate and efficient in data entry. Excel experience is a plus but not 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.