Financial Care Counselor - Duke Otolaryngology of South Durham
Duke University Health System
Location: Durham, North Carolina
Admin / Clerical
Internal Number: 197006
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 Primary Care. 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 Dukeâ€™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.
Occ Summary Work PerformedKnowledge, Skills and Abilities LevelCharacteristicsExcellent communication skills, oral and written. Ab ilityto analyzeAnalyze insurance coverage and benefits for service to en suretimelyPosition responsible forhigh production generated accurately inAccurately complete patient accounts based on departmental protocol,Gr eetandrelationships with patients,business processes or regulation. Requ ires working knowledge ofcollection actions and assistmedications.polici esand procedures,and compliance with regulatory agencies, to include but notlimited topre-admission, admission,pre-registration and registrationf unctions. Ensure allinsurancerequirements are met prior to patipatients' arrival and inform patients of their financial liabilityprior to arriva lfor services. Arrangepaympayment options with the patients and screens patients for governmentfunding sources.filing of claims andreimbursement .Obtain authorizations based on in/out network benefits, payment oninsurance, , plan contracts andguidelines. Document billing system Explainbil ls, provides assistanceto visitors and patients. EExplain policies and d epartmental coverage as requested.Calculate and according to PRMO credit and collectionpolicies.Implement appropriate collectionsand cash payment s appropriately for all patients. Reconcile dailynecessity of third part ysponsorship and process patients in accordance to reimbursement.Obtaina ll Prior AuthorizationCertification and/or authorizations as appropriate . Facilitate paymentsources for uninsuredpatients. Determine if patient' s condition is the result of an accidentand perform complete researchtod etermine the appropriate source of liability/payment. Admit,register and pre-register patientswith accuratepatient demographic and financialdat a. Resolve insuranceclaim rejections/denialsand remedy expediently.Evalu ate diagnoses to ensure compliance with the Local Medicare ReviewPolicy. Perform those ddutduties necessary to ensure all accounts areprocessed accurately andefficiently. Compile depdepartmental statisticsfor budgeta ry and reporting purposes.financially responsible personsinarrangingpaym ent. Make referral fofor financial counseling. Determine withDetermine w ith policy and procedure. Examine insurance policies and otother third p arty sponsorship materials for sources of payment. Informattending physi cian of papatient financial hardship. Complete the managedcare waiver fo rm forpatients considered out ofnenetwork and receiving services ata reduced benefit level. Update thebilling system to reflectthe ininsurance s tatus of the patient. Refer patients to the ManufacturerDrug program as needed for meprocedures, and resolves problems. Gathersnecessary documen tation tosupport proper handlingof inquiries and complaints. Assistaccor ding to policy and procedure.Enter and update referralsas required. Comm unicate with insurance carriers regarding clinicalinformation requested and toresolve issues relating to coverage.physicians,co-workers and supe rvisors. data, perform multiple tasksand work independently.Must be able to develop and maintain professional, service-orientedworking styles.Mu st be able to understand and comply with policies and procedures.accorda nce with established ballows the opportunity to workindependently.compli ance principles. Job a
Work requires knowledge of basic grammar and mathematical principles normally required through a high schooleducation, 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
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