FINANCIAL CARE COUNSELOR

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 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.

Monday- Friday, 8:30a-5:00p, Some backup Late night coverage 

Occ Summary 

Occ Summary 

Accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, including but not limited to pre-admission, admission, pre-registration, and registration functions. Ensure all insurance requirements are met before patients' arrival and inform patients of their financial liability before arrival for services. Arrange payment options with the patients and screen patients for government funding sources.

Work Performed

Analyze insurance coverage and benefits for service to ensure timely reimbursement. Obtain all Prior Authorization Certification and /or authorization 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/payment. Admit, register, and pre-register patients with accurate patient demographic and financial data. Resolve insurance claim rejections /denials and remedy expediently. Calculate and collect cash payments appropriately for all patients. Reconcile daily cash deposit. Evaluate diagnoses to ensure compliance with the LocalMedicare Review Policy.

Performing those duties is 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 a referral for financial counseling. Determine the necessity of third-party sponsorship and process patients by 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 as needed for medications. Greet and assist visitors of the patient. Refer patients to the Manufacturer Drug program for patients. Explain policies and procedures, and resolves problems. Gathers necessary 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 required. Communicate with insurance carriers regarding clinical information requested and resolve issues relating to coverage and payment.

Knowledge, Skills, and Abilities

Excellent communication skills, oral and written. Ability to analyze data, perform multiple tasks, and work independently. Must be able to develop and maintain professional, service-oriented working relationships with patients, physicians, co-workers, and supervisors.Must be able to understand and comply with policies and procedures.

Level Characteristics

Position responsible for high production generated accurately by established business processes or regulations. Requires working knowledge of compliance principles. The job allows the opportunity to work independently.

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.

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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.