- Requisition Number: 15327
- Department: PRMO
- Location: Durham
- Type of Position: Regular
- Shift: Full Time
PRMO:, established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke PrimaryCare. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke’s reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.
Accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, to include but not limited to pre-admission, admission, pre-registration and registration functions.
Ensure all insurance requirements are met prior to patients' arrival and inform patients of their financial liability prior to arrival for services. Arrange payment options with the patients and screens patients for government funding sources.
- Analyze insurance coverage and benefits for service to ensure timely.
- Obtain authorizations based payment on insurance plan contracts and guidelines.
- Document billing system.
- Explain bills provides assistance to visitors and patients.
- Explain policies and departmental coverage as requested.
- Calculate and according to PRMO credit and collection policies.
- Implement appropriate collect cash payments appropriately for all patients.
- Reconcile daily necessity of third party sponsorship and process patients in accordance reimbursement.
- Obtain all Prior Authorization Certification and/or authorizations as appropriate.
- Facilitate payment sources for uninsured patients.
- Determine if patient's condition is the 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.
- 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.
- Collection actions and assist financially responsible persons in arranging payment.
- Make referral for financial counseling.
- Determine with policy and procedure.
- Examine insurance policies and other third party sponsorship materials for sources of payment.
- Inform attending physician of patient 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 needed for medications.
- Greet and procedures, and resolves problems.
- Gathers necessary documentation to support proper handling of inquiries and complaints.
- Assist with according to policy and procedure.
- Enter and update referrals as required.
- Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage
Knowledge, Skills and Abilities
- Excellent communication skills, oral and written.
- Ability to analyze relationships with patients, physicians, co-workers and supervisors. data, perform multiple tasks and work independently.
- Must be able to develop and maintain professional, service-oriented working,
- Must be able to understand and comply with policies and procedures.
- Position responsible for high production generated accurately in accordance with established business processes or regulation.
- Requires working knowledge of compliance principles. Job allows the opportunity to work independently.
Shifts may vary between the hours of 7:30 a.m. - 5:00 p.m. based on department need
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.
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
Job Code: 00004500 FINANCIAL CARE COUNSELOR
Job Level: C1
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.
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Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job 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.