PATIENT FINANCIAL COORDINATOR - BLOOD CANCER CENTER

Employer
Duke University
Location
BLOOD CANCER CENTER

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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.

Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Patient Financial Coordinator who will embrace our mission of Advancing Health Together. General Description of the Job Class

The Patient Financial Coordinators (PFCs) are part of a multidisciplinary team charged with the responsibility of providing accurate and professional financial clearance to patients seeking Transplant Services or Chemotherapeutic Services at Duke. The PFCs are responsible for the analysis, validation and regulatory and compliance activities associated with the financial clearance process. The PFCs mitigate the financial risk to Duke by performing an accurate financial clearance review along with a comprehensive analysis of patient and payor specific benefits and patient liability. Coordination and communication with the patient, clinical teams including physicians, nurses, social workers and pharmacists is key for the successful financial analysis and clearance.

Work is performed under the direct supervision of the Transplant Financial Services Manager or Financial Services Manager with administrative direction provided by the Administrative Director of Service Access.

Duties and Responsibilities of this Level

Process New Referrals for Evaluation / Insurance Verification/Clinical Coordination:

Analyze, organize, and utilize complex data and rules related to contracting and patient benefits to provide financial clearance; work with DUHS Finance, Managed Care Contracting, Pharmacy assistance programs in the development of agreements for International, self funded patients and patients with limited benefits; interact with Transplant / Oncology Clinical teams (Surgeon, Medical Oncologists, RN Coordinators and Transplant Administration) to obtain treatment plans, discharge planning, concurrent and retrospective review and patient demographics to begin insurance verification process; interview admitted patients to obtain required information to begin verification; interact with Clinical teams (Surgeon, RN Coordinators and Administration) prior to a patient's financial clearance, providing key information and data regarding benefits, support and patient financial liability; prepare financial packets based on each individual patient's benefits, patient financial interview, and calculated estimated expenses based on patient benefits; share financial screen daily / weekly with the clinical teams at each of their respective meetings; notify the patient if not financially approved for evaluation at Duke and redirect these patients to the insurance payer's case manager.

Data Maintenance and Billing Information (Transplant specific):

Identify the correct patient in IDX and accurately identify which account is to be used for the visit; update demographic and insurance information in IDX and the transplant database when informed of changes; perform a review of each patient visit to determine if a visit was transplant related in order for accurate billing to occur; communication with the clinicians occurs daily to confirm some visit requirements; on-going financial review /analysis, review and analyze patient's eligibility, benefit changes and financial status once a patient is accepted for evaluation and through transplant; patients are followed approximately up to one year post transplant by the PFC; provide weekend and evening coverage for solid organ transplant referrals in an effort to provide timely financial feedback to the surgeons.

Patient Identification / Pre-registration:

Identify the correct patient in IDX and other systems (ie/ Concert) and accurately identify which account is to be used for the visit; update demographic and insurance information in IDX; obtain a Duke Medical Record number for new patients; analyze benefits for appropriate coverage for services, review contracts and obtain clarification from Managed Care Contracting and Payor Coordination as needed; resolve IDX system alerts for missing or incorrect registration and insurance elements; add / edit insurance per policy and procedure; clear TES edits and Hold bills; obtain authorizations and pre-certifications as required; work with clinical staff to obtain additional clinical information for benefit review in particular as it relates to clinical trials and off label drug use.

Interview Patients / Provide Financial Counseling:

Meet with patients and family members at the time of transplant evaluation or prior to chemotherapeutic treatment; inform patients of the anticipated costs of transplant /chemotherapeutic services, the anticipated patient liability, and the patient responsibilities (e.g. post transplant medications); assist patients with a financial plan when not adequately funded for transplant (e.g. fundraising) or therapy services; implement appropriate collection actions and assist financially responsible persons in arranging payment; explain billing to patients according to PRMO credit and collection policies; evaluate patient requests for financial assistance; notify the Transplant clinical team of financial considerations that prevent or delay listing the patient for transplant; inform the Oncology Clinical team of financial considerations, seek clinical assistance as needed; refer patient's to the Manufacturer Drug program and Pharmacy Assistance programs as needed for medications.

Obtaining Authorization and Prior Approval:

Analyze benefit requirements and initiate the request for authorization/prior approval for the transplant evaluation, admission, clinic visits, donor compatibility, work-up and testing, organ procurement, and follow-up appointments; analyze benefit requirements and initiate authorization, pre-certifications and /or pre-determinations for chemotherapy treatments; work with clinical staff to obtain additional clinical information for benefit review in particular as it relates to clinical trials and off label drug use; prepare the medical packet (including letter of medical necessity and clinical evaluation) required for obtain prior approval, authorization, or pre-certification; document authorizations in IDX per policy and procedure; review denials for evaluation and/or transplant and initiate the appeal process with the insurance payer working collaboratively with the patient, family, and physician; work collaboratively with the oncologists for treatment authorization denials and work proactively with the oncologist, drug manufacturer and payor to obtain coverage and prevent post billing authorization denials.

Customer Service:

Greets and provides assistance to visitors and patients. Explains policies and procedures, and resolves problems; gathers necessary documentation to support proper handling of inquiries/complaints; courtesy and professional conduct is maintained at all times; provides timely and effective service to internal customers.

Case Management (Transplant):

Set the next review date in the transplant registration screen to trigger the next period financial verification; request updates to the effective and termination dates of the transplant approval when expired; review outpatient appointments for active transplant registered patients and resolve any issues related to coverage and payment. Identify operational improvements to maximize efficiency and effectiveness of services provided. Communicate opportunities to management.

Perform other related duties incidental to the work described herein.

Required Qualifications at this Level

Education

High School Diploma required. Advanced degree preferred.

Experience

Three years of healthcare experience with a minimum of one year in insurance verification, authorization, or billing experience required. One year of experience with a transplant or chemotherapy program preferred.

Degrees, Licensure, and/or Certification

Position may be subject to membership with the Transplant Financial Coordinators Association (for Transplant team)and may be subject to certification with TFCA.

Knowledge, Skills, and Abilities

Ability to effectively work with professionals and non- professionals in situations of high complexity and high intensity in a positive and professional manner. Taking care to being sensitive in communication with all customers, internal and external, anticipating and striving to reduce levels of stress, fear, concerns and difficulties as it relates to transplant and oncology business services Strong verbal and written communication skills mandatory.

Ability to analyze data and benefit information

Ability to calculate patient estimates and liabilities /responsibilities

Data entry experience

Basic PC skills

Medical terminology knowledge

Knowledge and understanding of telephone etiquette

Ability to organize and prioritize

Ability to understand and follow oral and written instructions

Ability to interact tactfully and courteously with the public

Ability to apply specific departmental policies, rules and regulations relating to verifying patient information, collecting payments and maintaining records and forms

Ability to establish and maintain effective relationships with other personnel

Ability to multitask

Distinguishing Characteristics of this Level

On occasion overtime or weekend work may be required. Position may be subject to responding to urgent or emergent transplant team requests.

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.

Organization

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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