FINANCIAL CARE COUNSELOR - SPEECH PATHOLOGY & AUDIOLOGY

Job description

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.

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.

Job Summary

  • Appropriately verifies insurance and benefits for reimbursement.
  • Verifies existing coverage (payer/plan is appropriate, eligibility, benefits, etc.); enters new coverage as required completely and accurately.
  • Use RTE when available, addressing alerts and selecting and applying the correct coverage in MaestroCare.
  • When manually entering coverage; enter all core benefits (e.g. out of pocket max, lifetime max, deductible amount).
  • Determines the coordination of benefits correctly.
  • Enters termination dates of expired insurance as necessary.
  • As appropriate, coordinates with the department/provider on patients who do not have any or sufficient coverage for the services to be rendered.
  • Assists in rescheduling or other next steps processes (see below) if the patient does not meet emergent/urgent criteria.
  • Obtain pre-determination, referrals, authorizations, pre-certification, or prior approvals based on guidelines of health plan.
  • Required authorizations, prior approvals, pre-certifications obtained at the time of service or a Waiver/Payment Agreement completed with the patient.
  • Authorization requests initiated for procedures ordered within 72 hrs following the clinic visit or based on emergent/urgent scheduling.
  • Authorization, pre-certification numbers entered in the appropriate authorization fields in MaestroCare; referral statuses updated appropriately.
  • Assures the authorization is appropriate for the services to be delivered.
  • Pre-determination initiated for procedures suspected to be non-covered (e.g. new drugs or procedures without clinical coverage policies).

Work Performed

  • 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.

Level Characteristics

  • 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.

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. Must have experience in obtaining insurance authorizations.

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.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

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.

 

 

 

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Job No:
Posted: 8/29/2020
Application Due: 11/27/2020
Work Type:
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