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PATIENT ACCOUNT ASSOCIATE - PROVIDER ENROLLMENT - PROVIDER ENROLLMENT

Employer
Duke University
Location
PROVIDER ENROLLMENT

Job Details

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.

General Description of the Job Class:

Resolve account balances related to authorization denial s for Duke University Health System hospital and professional claims. Research issues pertaining to delayed payments and identify areas of process improvements needed to expedite A/R resolution. Conduct follow-up on balance outstanding with insurance payers. Resolve accounts in a timely and accurate manner, one that maximizes reimbursement in compliance with payer regulations.

Duties and Responsibilities of this Level:

Authorization Denial Follow-up 75%

  • Conduct follow-up of balances outstanding with insurance payers due to authorization denials and take action for resolution via payment, write-off, or transfer/rebilling of balance to another responsible party
  • Research denied claims, address outstanding issues, and appeal denials to receive payment
  • Resolve assigned accounts in a timely and accurate manner, in a manner that maximizes reimbursement in compliance with payer regulations and PRMO policy and procedure
  • Resolve assigned accounts in a timely and accurate manner, in a manner that maximizes reimbursement in compliance with Pre-Service Verification/Authorization Denials policy and procedure
  • Consistently achieve an d maintain performance standards for assigned productivity, collections, and quality targets per PRMO Overall Effectiveness Rating policy

DUHS Team Support 25%

  • Complete Customer Service inquiries in a timely manner
  • Identify trends in workflows and report outstanding operational issues to management for further research and resolution
  • As requested by management, provide support to other employees within team or on another team to address inventory backlogs or staffing shortages
  • Collaborate with other departments as needed for process improvement when issues are identified
  • Coordinate coverage as needed with team members to ensure A/R man aged in a timely manner according to Policy
  • Other duties as assigned

Required Qualifications at this level:

Position requires analytical, organizational and communications skills generally acquired through completion of a Billing and Collection Study Program, or an equivalent amount of work experience.

Knowledge, Skills, and abilities:

  • Working knowledge of managed care contracting and payment schedules
  • Excellent communication skills, oral and written
  • Ability to systematically analyze problems, draw relevant conclusions a nd devise appropriate course of action
  • Ability to analyze data, perform multiple tasks and work independently
  • Must be able to develop and maintain professional, service- oriented working relationships with senior leadership, patients, physicians, co-workers and employees.
  • Ability to work in a fast paced environment, with focus on team building
  • Experience with patient account billing systems

System Experience:

  • Maestro Care(Epic) Preferred
  • Microsoft Word Required
  • Microsoft Excel Required
  • Microsoft Powerpoint Preferred
  • SSI (Claims Scrubber) Prefer red
  • Hyland (Imaging Solution) Preferred

Distinguishing Characteristics of this Level

The successful candidate will possess a wide range of personality traits, work habits, communication and social skills necessary to perform and work effectively within the corporate environment. This person will have both personal and professional integrity, strong communication skills and a professional appearance and presentation. In addition, the qualified candidate will have a strong desire to succeed in a challenging environment.

Other competencies and best practices for high performers include:

  • Integrity and compliance: Can be relied upon to act ethically, to safeguard confidential information and to adhere to the Hospital’s Mission and Code of Conduct and all legal and regulatory requirements
  • Decision-making: Makes quality decisions in a timely manner
  • Coaching and developing others: Guides others in per forming effectively and provides others with development opportunities; provides direction without moving responsibility and allows others to determine the best approach to executing assignments
  • Team Building: Demonstrate solid skills in working with a large diverse workforce in a complex operating environment

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 access, physician office or billing and collections or an equivalent combination of relevant education and/or experience.

Degrees, Licensures, Certifications

N/A

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.

Organization

Read our Diversity Profile History

Duke University was created in 1924 by James Buchanan Duke as a memorial to his father, Washington Duke. The Dukes, a Durham family that built a worldwide financial empire in the manufacture of tobacco products and developed electricity production in the Carolinas, long had been interested in Trinity College. Trinity traced its roots to 1838 in nearby Randolph County when local Methodist and Quaker communities opened Union Institute. The school, then named Trinity College, moved to Durham in 1892, where Benjamin Newton Duke served as a primary benefactor and link with the Duke family until his death in 1929. In December 1924, the provisions of indenture by Benjamin’s brother, James B. Duke, created the family philanthropic foundation, The Duke Endowment, which provided for the expansion of Trinity College into Duke University.Duke Campus

As a result of the Duke gift, Trinity underwent both physical and academic expansion. The original Durham campus became known as East Campus when it was rebuilt in stately Georgian architecture. West Campus, Gothic in style and dominated by the soaring 210-foot tower of Duke Chapel, opened in 1930. East Campus served as home of the Woman's College of Duke University until 1972, when the men's and women's undergraduate colleges merged. Both men and women undergraduates now enroll in either the Trinity College of Arts & Sciences or the Pratt School of Engineering. In 1995, East Campus became the home for all first-year students.

Duke maintains a historic affiliation with the United Methodist Church.

Home of the Blue Devils, Duke University has about 13,000 undergraduate and graduate students and a world-class faculty helping to expand the frontiers of knowledge. The university has a strong commitment to applying knowledge in service to society, both near its North Carolina campus and around the world.

Mission Statement

Duke Science"James B. Duke's founding Indenture of Duke University directed the members of the University to 'provide real leadership in the educational world' by choosing individuals of 'outstanding character, ability, and vision' to serve as its officers, trustees and faculty; by carefully selecting students of 'character, determination and application;' and by pursuing those areas of teaching and scholarship that would 'most help to develop our resources, increase our wisdom, and promote human happiness.'

“To these ends, the mission of Duke University is to provide a superior liberal education to undergraduate students, attending not only to their intellectual growth but also to their development as adults committed to high ethical standards and full participation as leaders in their communities; to prepare future members of the learned professions for lives of skilled and ethical service by providing excellent graduate and professional education; to advance the frontiers of knowledge and contribute boldly to the international community of scholarship; to promote an intellectual environment built on a commitment to free and open inquiry; to help those who suffer, cure disease, and promote health, through sophisticated medical research and thoughtful patient care; to provide wide ranging educational opportunities, on and beyond our campuses, for traditional students, active professionals and life-long learners using the power of information technologies; and to promote a deep appreciation for the range of human difference and potential, a sense of the obligations and rewards of citizenship, and a commitment to learning, freedom and truth.Duke Meeting

 “By pursuing these objectives with vision and integrity, Duke University seeks to engage the mind, elevate the spirit, and stimulate the best effort of all who are associated with the University; to contribute in diverse ways to the local community, the state, the nation and the world; and to attain and maintain a place of real leadership in all that we do.”

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