About the position
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. The Patient Revenue Management Organization is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions. The position of Financial Care Counselor involves accurately completing patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, to include but not limited to pre-admission, admission, pre-registration and registration functions.
Responsibilities
- Analyze insurance coverage and benefits for service to ensure timely processing.
- Obtain authorizations based on insurance plan contracts and guidelines.
- Document billing system accurately.
- Explain bills and provide assistance to visitors and patients.
- Explain policies and departmental coverage as requested.
- Calculate and collect cash payments appropriately for all patients.
- Reconcile daily necessity of third party sponsorship and process patients in accordance with reimbursement.
- Obtain all Prior Authorization Certification and/or authorizations as appropriate.
- Facilitate payment sources for uninsured patients.
- Determine if patient's condition is the result of an accident and perform complete research to determine the appropriate source of liability/payment.
- Admit, register and pre-register patients with accurate patient demographic and financial data.
- Resolve insurance claim rejections/denials expediently.
- Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy.
- Compile departmental statistics for budgetary and reporting purposes.
- Assist financially responsible persons in arranging payment.
- Make referrals for financial counseling.
- Examine insurance policies and other third party sponsorship materials for sources of payment.
- Inform attending physician of patient financial hardship.
- Complete the managed care waiver form for patients considered out of network and receiving services at a reduced benefit level.
- Update the billing system to reflect the insurance status of the patient.
- Refer patients to the Manufacturer Drug program as needed for medications.
- Greet patients and resolve problems.
- Gather necessary documentation to support proper handling of inquiries and complaints.
- Enter and update referrals as required.
- Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage.
Requirements
- Work requires knowledge of basic grammar and mathematical principles normally required through a high school education, with some postsecondary education preferred.
- Two years experience working in hospital service access, clinical service access, physician office or billing and collections.
- 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.
Benefits
- DUHS Commitment Bonus Program $5000.00 (paid in 2 installments over 12 months - 6 month increments)
- Only new hires who have not worked for Duke University in the past 12 months (at the time of offer) are eligible to receive the commitment bonus.
