PATIENT ACCOUNT ASSOCIATE - DENIALS
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
- 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
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 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
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.