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.
Accurately complete patient accounts ba sedondepartmental protocol,policies and procedures, and compliance with regulatory agencies, toinclude but not limited to pre-admission, admissi on,pre-registrationand registrationfunctions. Ensure all insurance requ irements are metprior to patients' arrival and inform patients of their financialliability prior toarrivalfor services. Arrange payment options withthe patientsand screens patients for government funding sources.
Analyze insurance coverage and benefits forservice to ensure timelyreimbursement. Obtain all Prior Authorizatio nCertification 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 P olicy. Perform those duties necessaryto ensure allaccounts are processe daccurately and efficiently. Compile departmentalstatistics for budgetar yand reporting purposes.Explain billsaccording to PRMO credit and collec tion policies. Implement appropriatecollection actions and assist financ ially responsible persons inarranging payment. Make referral for financi alcounseling. Determinenecessity of third party sponsorship and processp atients in accordancewith policy and procedure. Examine insurance polici es and other thirdparty sponsorship materials for sources of payment.Inf orm attendingphysician of patient financial hardship. Complete the manag ed carewaiver form for patients considered out of network and receivings ervices at a reduced benefit level. Update the billing system toreflect the insurance status of the patient. Refer patients to theManufacturerDr ug program as needed formedications. Greet andprovides assistanceto visi tors and patients. Explain policies andprocedures, and resolves problems .Gathers necessary documentation tosupport proper handling of inquiriesa nd complaints. Assist withdepartmental coverage as requested.Obtainautho rizations basedon insurance plan contracts and guidelines. Document bill ing systemaccording to policy and procedure. Enter and updatereferralsasrequired. Communicate with insurance carriers regarding clinicalinformat ion requested and to resolve issues relating to coverage andpayment.
Knowledge, Skills and Abilities
Excellent communication skills, oral and written. Ability to analyzedata, perform multiple task s and work independently. Must be able todevelop and maintain profession al, service-oriented workingrelationshipswith patients, physicians, co-w orkers and supervisors.Must beable to understand and comply with policies and procedures.
Position resp onsible for high production generated accurately inaccordance with estab lished business processes or regulation. Requiresworking knowledge ofcom pliance principles. Job allows the opportunityto work independently.
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 to five years experience working in hospital access, physician office or billing and collections or an equivalent combination of relevant education and /or experience
Degrees, Licensures, Certifications
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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.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.