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.
Analyze insurance coverage and benefits for service to ensure timely reimbursement. Obtain all prior authorizations, 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 or payment. Admit, register, and pre-register patients with accurate patient demographic and financial data.* Resolve insurance claim rejections/denials and remedy them expediently. Calculate and collect cash payments appropriately for all patients.
Reconcile the daily cash deposit. Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy. Perform those duties necessary to ensure all accounts are processed accurately and efficiently. Compile departmental statistics for budgetary and reporting purposes. Explain bills according to PRMO credit and collection policies. Implement appropriate collection actions and assist financially responsible persons in arranging payment. Make referrals for financial counseling.* Determine the necessity of third-party sponsorship and process patients in accordance with policy and 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's drug program for prescribed medications.
Greet and assist visitors and patients.* Explain policies and procedures, and resolve problems.*Gathers required documentation to support proper handling of inquiries and complaints. Assist with departmental coverage as requested.* Obtain authorizations based on insurance plan contracts and guidelines. *Document billing system according to policy and procedure.* Enter and update referrals as requir ed.* Communicate with insurance carriers regarding clinical information requested and resolve issues relating to coverage; excellent communication skills, both oral and written. Ability to analyze relationships with patients, physicians, co-workers, and, supervisors. work independently. Must be able to develop and maintain professional standards and comply with policies and procedures.data, perform multiple tasks, and do service-oriented work. Obtain and accordance authorizations based on. Must be able to understand and comply with established payments.
The position is accurately responsible for the high production generated by uninsured patients. Determine if the patient's condition is the result of inaccurately completing patient accounts based on departmental protocol, insurance plan contracts, and guidelines. Document billing system Explain bill research to determine the appropriate source of liability/payment. Greet, andCalculate and assist visitors and patients. Explain policies according to policy and departmental coverage as requested. according to PRMO credit and collection policies. Implement appropriate rejections or denials and remedy and remedy expediently. business processes or regulation. Requires working knowledge of procedure. Enter and update referrals as required. Communicate with coverage and resource sources.
Clinical information requested to resolve issues relating to facilitating payment sources for insurance carriers regarding authorization regulatory Certification and/or authorizations as appropriate.insurance claim policies and procedures, and compliance with regu latory agencies, including but not limited to patients with accurate patient demographic and financial data. Resolve registration and registration functions. Ensure all insurance collects cash payments appropriately for all patients. Reconcile the daily necessity of third-party sponsorship and process patients in accordance with. Gathers the necessary documentation to support the handling of inquiries and the opportunity to work independently. pre-admission, pre-examine insurance policies, and other third-party sponsorship material for budgetary and reporting purposes.financially responsible persons in arranging payment. Make referrals for needed medications. Admit, register, and pre-register to ensure all accounts are processed accurately and efficiently. Compile to reflect the insurance status of the patient. Refer patients to ensure compliance with the Local Medicare Review Policy. Perform options with the patients and screen patients for government funding, informing physicians of patients financial hardship. Complete the managed reimbursement. Obtain all prior policy procedures, arrivals, and procedures. Arrival for services. Arrange payment and inform patients of their financial liability before departmental statistics for the manufacturer drug program. Those duties are necessary to collect actions, assist in an account, and perform complete financial counseling. Update the billing system for sources of payment. Informand complaints. Assist with the cash deposit. Evaluate diagnoses and 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, 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.
