Financial Care Counselor - DRAH Outpatient Service Access

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. The Patient Revenue Management Organization (PRMO) is the fully integrated, centralized revenue cycle organization supporting the entire health system in streamlining scheduling, registration, coding, billing, and other essential revenue functions.

About the role

Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Financial Care Counselor who will embrace our mission of Advancing Health Together. This role involves accurately completing patient accounts based on departmental protocols, policies, and compliance with regulatory agencies, including pre-admission, admission, pre-registration, and registration functions.

Responsibilities

• Analyze insurance coverage and benefits to ensure timely payment and obtain authorizations based on insurance plan contracts and guidelines.
• Document in the billing system and explain bills, providing assistance to visitors and patients.
• Explain policies and departmental coverage as requested.
• Calculate and collect cash payments according to PRMO credit and collection policies.
• Reconcile the necessity of third-party sponsorship and process patients in accordance with reimbursement requirements.
• Obtain all Prior Authorization Certification and/or authorizations as appropriate.
• Facilitate payment sources for uninsured patients.
• Determine if a patient's condition is the result of an accident and perform complete research to identify the appropriate source of liability/payment.
• Admit, register, and pre-register patients with accurate demographic and financial data.
• Resolve insurance claim rejections/denials expediently.
• Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy.
• Perform duties necessary to ensure all accounts are processed accurately and efficiently.
• Compile departmental statistics for budgetary and reporting purposes.
• Take collection actions and assist financially responsible persons in arranging payment.
• Make referrals for financial counseling in accordance with policy and procedure.
• Examine insurance policies and other third-party sponsorship materials for sources of payment.
• Inform attending physicians 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 patients, explain procedures, and resolve problems.
• Gather necessary documentation to support proper handling of inquiries and complaints.
• Assist with tasks according to policy and procedure.
• Enter and update referrals as required.
• Communicate with insurance carriers regarding clinical information requested and resolve coverage issues.

Requirements

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

Qualifications

Education: Work requires knowledge of basic grammar and mathematical principles normally acquired through a high school education, with some postsecondary education preferred. Additional training or working knowledge of related business is beneficial.

Experience: Two years of experience working in hospital service access, clinical service access, physician office, or billing and collections. Alternatively, 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.

Benefits

• DUHS Commitment Bonus Program: $5,000 (paid in 2 installments over 12 months in 6-month increments). Only new hires who have not worked for Duke University in the past 12 months (at the time of offer) are eligible.

Level Characteristics

This position is responsible for high production generated accurately in accordance with established business processes or regulations. The role allows the opportunity to work independently.