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 Primary Care. 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.

Occ Summary

Answer and respond to all PRMO-related cust omer issues that are receivedby way of telephone, in person and/or writi ng,meeting customer anddepartmental goals and objectives.

Wo rkPerformed

Answer and resolve all inbound inquiries and issues r egarding patientaccount statements, bad debt write off's, explanation of benefits,balance due, and other patient and insurance billing related sc enarios.Analyze the patient's problem or issue that is presented by coll ectinginformation and data and conducting thorough research of the IDX p atientaccounting systems, Hyland Onbase for documents that may have been imaged (EOBs, statements, admitting documentation, patientcorrespondence , etc.), Passport or BlueE for eligibility, researchingpayor websites an d/or contacting the payor is needed. Analyzeinformation for an appropria tesolution and take the necessary actionneeded to resolve the issue.Foll owthrough on all customer issues promptly and accurately untilcompletion .Open work items include issues that are tracked via PCSworkfiles, the c ustomer service follow up database and paper workfiles.Thoroughly update and document PCS notes orsystem comment fields withall information perta ining to an inquiry (i.e. questions, answers,actions, follow up itemsreq uired).Communicate with the patient, physicians, collection agency, inte rnaldepartments and all other internal and external customers in aprofes sional, courteous, and respectful manner.Post customer service adjustmen ts when supported by policy, contractualadjustments and other adjustment s as deemed necessary followingappropriate write off guidelines.Update i nsurance information and file and/or appeal claims withinsurance compani es according to department guidelines. Take appropriateactions to bill i nsurance companies or patients with correctedinformation including accep ting and inputting secondary insuranceinformation into the system andfil ing claims.Coordinate patient refund requests with the credit balance de partment.Research EOB?sand payment detail to determine if apatientrefund isnecessary or determine the nature of the credit balance.Provide finan cial counseling to patients, guarantors, and attorneysregarding chargesf or health care services. Validate that charges arecorrect and requestmed ical review and audit when necessary.Discuss and establish payment plans for patients that require extendedterms to pay off a balance.Produceite mized statements. Mail and provide itemized statements topatients when r equested.Assist patients that are requesting charity care by conducting aninitial screening and sending or providing that patient a copy ofthech arity care application when requested. Provide feedback regardingstatus of the application when requestedfrom a patient.Obtain and post credit card payments for accounts including authorizedsettlements within depart mental guidelines. Follow department policynecessary for charge correcti ons, transferring credits, coding changes,service and chargedisputes, an d locate payments.Following appropriate policy, update all system inform ation toaccessible fields to include correct registration information, a ddress,telephone numbers, guarantor information, employer information,in surance information, etc.Identifytrends in system problems,training or procedural concerns.Make recommendations and provide feedback regarding corrective andpreventive action to the supervisor or manager. Trackthe p roblem toensure the inquiry is completed through PSC workfiles orthe fol low updatabase.Adhere to all HIPAA and confidentiality guidelines.Work w ith a diverse group of internal and external customers (i.e.attorneys, i nsurance companies, state agencies, physician offices,collectionagencies , etc).Work asa team member towards common goals.Prepare and /or assist with special reports as requested by management.Adhereto a schedule to ensure customer availability and demonstrateflexibility to schedules acc ording to patient or call volume or staffingneeds.Perform otherrelated d uties incidental to the work described herein.

Knowledge, Sk ills and Abilities

Analytical and problem-solving skillsStrong or ganizational skills with the ability to multi-task and followthrough on outstanding issuesStrong computer skills with knowledge of MS Word, MS E xcel and e-mailExcellent interpersonal skills with the abilityto communi cateeffectively both orally and in writingAbility towork wellwith others - strong teamwork skillsMust be flexible and ableto functionin a work e nvironment where workand schedules may change tomeet the needs of the pa tientDemonstrated ability to work well withcustomers and deliver excelle ntcustomer serviceAbility to control and manage a phone callBi-lingual p referredKnowledge of DUHS billing preferred

Minimum Qualifications

Education

Work requires knowledge of basic grammar and mathematical principles normally required through a high school education. Two-year college degree preferred.

Experience

A minimum of three years direct customer service or call center preferred. operations experience is required. A healthcare background working in medical billing, collections, insurance claims processing, coding, registration, working in a medical organization, or like experience in the fields of education, training, training development, is highly Inbound to outbound call center experience preferred. Working knowledge of Maestro Care system preferred.

Degrees, Licensures, Certifications

N/A

 

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.