FINANCIAL CARE COUNSELOR - ANCILLARY SERVICE ACCESS
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.
The Financial Care Counselor is an integral part of the patient care team in the clinic /service area and is responsible for the financial revenue cycle front end related activities - such as financial counseling and clearance of patients, authorizations and referrals for procedures and services. Many Financial Care Counselors serve as a Cash Manager in the clinic. The Financial Care Counselor provides back up for the front desk registration activities. The Financial Care Counselor is responsible for living Duke’s values and demonstrating expected behaviors while contributing to creating a positive patient experience and building a positive work environment. The Financial Care Counselor will maintain a professional image in appearance and over the phone. The Financial Care Counselor contributes to ensuring the registration desk, Financial Care Counselor office and waiting areas safeguard patient privacy, confidentiality and safety and are well maintained and clean.
- Patient identification and Insurance verification
- Identify correct patient in Maestro Care.
- Verify and edit demographic and insurance information in Maestro Care as needed.
- Respond to warnings, alerts and confirmation checks presented; execute appropriate procedures to resolve.
- Verify insurance eligibility and benefits for reimbursement.
- Present and educate patients on required forms (MSP, COA/COT, ABNs, Waivers). Obtain signatures on forms as required and process forms per policy.
- Contact Risk management / Workman’s Compensation to coordinate billing/payment on accounts involving workman’s compensation claims.
- Provide financial counseling to reach account resolution
- Provide financial counseling to patients and their families regarding outstanding patient liability–co pays, deductibles, coinsurance and (self-pay) balances for healthcare services.
- Explain Duke’s Financial Assistance and billing policies to patients and their guarantors.
- Evaluate patient/guarantor assets and liabilities to determine ability to pay for services.
- Estimate/determine fees for services and assist patients and families in payment options.
- Determine necessity of third party sponsorship and process patients per policy and procedure. Examine insurance policies and other third party sponsorship materials for sources of payment.
- Implement appropriate collection actions and assist financially responsible persons in arranging payment.
- Evaluate patient requests for charity care or other medical assistance programs.
- Inform attending physician of patient financial hardship and need for interpreter services.
- Identify possible funding sources for uninsured patients (e.g. vocational rehabilitation).
- Counsel patients and complete the managed care waiver form for patients considered out of network and receiving services at a reduced benefit level.
- Refer patients to the Manufacturer Drug program/Pharmacy assistance programs as needed for medications as appropriate .
- Cash Management
- Obtain Imprest cash bag at the beginning of the shift.
- Request payment on patient liability per policy.
- Request deposit for confirmed self-pay visits per policy.
- Ensure that patient receives financial counseling if necessary, based on ability to pay and account status flags.
- Collect cash, check and credit card payments and prepare receipts.
- Balance cash collections to User Batch Report daily.
- Reconcile cash discrepancies as required.
- Secure cash appropriately at all times during clinic hours. Return cash bag at end of shift to Cash Manager.
- Customer Service, Safety and Work Culture
- Interact with patients, visitors and staff in a professional manner at all times. Be available and greet patients and visitors immediately upon presentation.
- Meet or exceed patient expectations at each encounter. Anticipate patients' needs; inform patients of delays; offer alternatives (cafeteria, reschedule).
- Consistently use “Words that Work” and RELATE in daily interactions with patients, their loved ones and each other.
- Provide directions, organize escorts, and arrange for interpreters and taxis as needed.
- Follow HEART/Service Recovery as needed and elevate concerns or situations to clinic leadership as soon as possible.
- Contribute to a positive work environment by living Duke’s values and demonstrating expected behaviors.
- Report safety issues timely to clinic leadership and report personal safety incidents within 24 hours of occurrence.
- Identify operational improvements to maximize efficiency and effectiveness of services provided. Communicate opportunities to management.
- Obtain authorizations based on insurance plan contracts/guidelines, document in Maestro Care system per policy and procedure.
- Enter and update referrals as required.
- Communicate with physicians and medical staff to obtain clinical information required for the authorization process as needed.
- Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment for specific patients.
- Integrate efforts with case management, social work and the utilization management team as necessary.
- Work queues/Reports
- Manage clinic work queues following appropriate policies and procedures. FCC Child Work queue, Claim Edit work queues (responsible for 100 level edits), Orders work queue, Account and Charge Review work queues as appropriate.
- Research and expedite denials in a timely manner. Participate in action planning to prevent future denials.
- Generate, analyze and/or interpret entity (PDC, DRH, DUH and DRAH) and PRMO specific reports relating to clinic/department performance and execute appropriate action.
- Attend meetings and training sessions
- Attend staff meetings and other clinic meetings as requested.
- Participate in all system, regulatory and policy training.
- Attend FCC education sessions.
- Comply with all regulatory and compliance policies and processes
- Perform other related clerical duties as assigned.
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 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
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.