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REIMBURSEMENT SPECIALIST

Employer
Duke University
Location
OUTPATIENT MEDICATION AUTHORIZATION
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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.

Reimbursement Specialist

General Description of the Job Class

The Reimbursement Specialist within is responsible for managing the special handling services and other miscellaneous duties that includes managing the pricing guide and provide overall support to the special handling process.

Duties and Responsibilities of this Level

  • Analyze and coordinate the pricing quote for fixed package surgery service.
  • Audits, validates, and reconciles charges for special handling services. Applies appropriate adjustments. Determines appropriate splitting of charges between Professional and Hospital accounts.
  • Distributes/posts charges to appropriate guarantors. Performs charge corrections. Performs split billing to ensure appropriate charges are billed to insurance or directly to the patient. Manage all pre-payment within special pricing Work queues in the assigned facility
  • Audits, validates, and reconciles prepayments and credits related to special handling services. Ensures payments are posted appropriately based on special pricing knowledge and knowledge of coverage of services.
  • Routinely monitors WQs to resolve any outstanding charges or undistributed cash.
  • Monitors financial outcomes for Duke Health and special handling patients. Works with appropriate stakeholders to resolve special handling billing issues.
  • Trend and report on performance indicators and goals. Identifies improvement opportunities based on audits. Participates in workgroups related to special handling processes.
  • Ensures comprehensive documentation for special handling workflows under purview. Provides education and training on special handling services as needed.
  • The specialist is responsible for resolving any self-pay payment related services requiring special pricing.
  • Coordinates and audits to improve processes related to revenue cycle, efficiency of charging and billing, and collection efforts in special pricing.
  • Coordinate communication between providers, clinics, finance and accounting.
  • Make recommendations to improve financial systems; perform in house audits of operating units; analyze deficiencies and report to manager/director.
  • Assist in developing and defining short and long term departmental specific goals and objectives.
  • Maintain professional relationship with internal and external agencies and professional organizations concerning operations.
  • Develop and provide job-specific training to new and existing employees within department.
  • Perform other related duties incidental to the work described herein.
  • The specialist is also responsible for managing any errors, stop bills, or edit for special pricing charges.

Required Qualifications at this Level

Education:

High school diploma or equivalent is required, preferably supplemented by post-secondary courses in Accounting, Finance, Economics, Business Administration or a related field.

Experience:

Four years of related experience in healthcare is required. A Bachelor's degree in a related field can substitute for the experience requirement.

Knowledge, Skills, and Abilities:

Data analysis and reporting Billing/Collections Insurance Claims Microsoft Office (Excel, Access, Word, PowerPoint) Good communication skills (verbal and written) are essential.

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.

Company

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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