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.
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
High School Diploma required. Advanced degree preferred.
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.
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