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