PATIENT SERVICE REPRESENTATIVE - OUTPATIENT MEDICATION
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.
Responsible for accurate and complete patient ac counts based ondepartmental protocol, policies and procedures, and compl iance withregulatory agencies, to include but not limited to pre-admissi on,admission, pre-registration andregistration functions. Ensure allins urance requirements are met prior to patients' arrival, and informpatien ts of their financial liability. Arranges payment options withthe patien ts and screens patients for government funding sources. Thisis position has high customer service with our payors and physicians byphone and req uires excellent customer service skills. This position isvery similar to the Financial Care Counselor. This position completesall preliminary wo rk. The Financial Counselor completes the work whenthe patient arrives.< /p>Work Performed
Analyze insurance coverage and benefi ts for service to ensure timelyreimbursement. Obtain all PAC and/or auth orizations as appropriate.Facilitate referral to Financial Services forpayment sources foruninsured patients. Determine if patient's condition is the result ofan accident, performing complete research to determine t he appropriatesource of liability/payment. Schedules and pre-register pa tients,correcting as necessary all patient demographic and financial dat a.Resolve insurance claim rejections/denials and remedy expediently. Cal lpatients to remind them to bring balances due, co-pays, co insuranceand deductible. Evaluate diagnoses to ensure compliance with the LocalMedic are Review Policy. Perform those duties necessary to ensure allaccounts are processed accurately and efficiently. Promote and maintainexcellence in customer service.Explain billing to patientsaccording to PRMO credit and collection policies, when discussinginsurance with patients. Implem ent appropriate collection actions andassist financially responsible per sons in arranging payment. Makereferral to Financial Services Representa tive for counseling.Determine necessity of third party sponsorship and p rocess patients perpolicy and procedure. Examine insurance policies and other third partysponsorship materials for sources of payment. Inform at tendingphysician of patient financial hardship. Update the billing syste m toreflect the insurance status of thepatient.Provides timely andeffec tive customer service to internal customers. Assist withdepartmental cov erage as requested.Obtain authorizations basedon insurance plan contract s / guidelines, document in billing systemper policy and procedure. Ente r and update referrals as required.Communicate with insurance carriers r egarding clinical informationrequested and to resolve issues relating to coverage and payment forspecific patients and benefits.
Kno wledge, Skills and Abilities
Excellent communication skills, ora l and written. Ability to analyzedata, perform multiple tasks and work i ndependently. Must be able todevelop and maintain professional, service- oriented workingrelationships with patients, physicians, co-workers and supervisors.Must be able to understand and comply with policies and proc edures.
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 to five 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
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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.