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.
Occ Summary Accurately complete patient accounts based on departme ntal protocol,policies and procedures,and compliance withregulatory agen cies, to include but not limited to pre-admission,admission, pre-registr ation andregistration functions.Ensure all insurance requirements are me t prior to patients' arrivaland inform patients of theirfinancial liabil ityprior toarrival for services. Arrange payment options with the patien tsandscreens patients forgovernment funding sources. Work Performed Anal yze insurance coverage and benefits for service to ensure timely Obta in authorizations basedpayment.on insurance plan contracts and guideline s. Document billing systemExplain billsprovides assistance to visitors a nd patients. Explain policies anddepartmental coverage asrequested.Calcu late andaccording to PRMO credit and collection policies. Implement appr opriatecollect cash paymentsappropriately for allpatients. Reconcile dai ly necessity of third party sponsorship andprocess patients in accordanc ereimbursement. Obtainall Prior Authorization Certification and/or autho rizations asappropriate. Facilitate paymentsources for uninsuredpatients .Determine if patient's condition is the result of an accidentand perfor m completeresearch to determine theappropriate source of liability/payme nt. Admit, register andpre-register patients with accuratepatient demogr aphic andfinancial data. Resolve insurance claim rejections/denials andr emedyexpediently.cash deposit. Evaluate diagnoses to ensure compliancewi th the LocalMedicare Review Policy.Perform those dutiesnecessary to ensu re all accounts are processed accurately andefficiently. Compile departm entalstatistics for budgetaryand reporting purposes.collection actionsan d assist financially responsible persons inarranging payment. Make refer ralfor financial counseling.Determine with policy and procedure. Examine insurancepolicies andother third partysponsorship materials for sources of payment. Inform attending physician of patient financial hardship.Com plete the managed carewaiver form for patientsconsidered out of network and receiving services at a reduced benefitlevel. Update the billingsyst em to reflect theinsurance status of the patient. Refer patients to the ManufacturerDrug program as needed formedications.Greet andprocedures, a nd resolves problems. Gathers necessary documentation tosupport proper h andlingof inquiries andcomplaints. Assist with according to policy and p rocedure. Enter andupdate referrals as required.Communicate withinsuranc e carriers regarding clinical information requested and toresolve issues relating tocoverage and Knowledge, Skills and Abilities Excellent commu nication skills, oral and written. Ability to analyzerelationships with patients,physicians, co-workersandsupervisors. data, perform multiple t asks and work independently.Must be able to developand maintainprofessio nal, service-oriented workingMust be able to understand and comply with policies and procedures. Level Characteristics Position responsible forhigh production generated accurately inaccordance with establishedbusine ss processes orregulation. Requires working knowledge of compliance prin ciples. Joballows the opportunity towork independently.
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
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