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 custome r issues that are receivedby way of telephone, in person and/or writing, meeting customer anddepartmental goals and objectives.

Work Performed

Answer and resolveall inbound inquiriesand issues reg arding patientaccount statements, bad debt write off's, explanation of b enefits,balance due, and other patient and insurance billing related sce narios.Analyze the patient's problem or issue that is presented by collectinginformation and data and conducting thorough research of the IDX pa tientaccounting systems, Hyland Onbase for documents that may have beeni maged (EOBs, statements, admitting documentation, patientcorrespondence, etc.), Passport or BlueE for eligibility, researchingpayor websites and /or contacting the payor is needed. Analyzeinformation for an appropriat esolution and take the necessary actionneeded to resolve the issue.Follo wthrough on all customer issues promptly and accurately untilcompletion.Open work items include issues that are tracked via PCSworkfiles, the cu stomer service follow up database andpaper workfiles.Thoroughly updatea nd document PCS notes or system 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 adjustments 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 refundrequests with thecredit balance de partment.Research EOB?s and payment detail to determine if a patientrefu nd isnecessary or determine the nature of the credit balance.Provide fin ancial counseling to patients, guarantors, and attorneysregarding charge s for health care services. Validatethat charges arecorrect and request medical review and audit when necessary.Discuss and establish payment p lans for patients that require extendedterms to pay off a balance.Produc e itemized statements. Mail and provide itemized statements topatients w hen requested.Assist patients that are requesting charity care by conduc ting aninitial screening and sending or providing that patient a copy of thecharity care application when requested. Provide feedback regardings tatus of the application when requested from a patient.Obtain and post c redit card payments for accounts including authorizedsettlements within departmental guidelines. Follow department policynecessary for charge co rrections, transferring credits, coding changes,service and chargedisput es, and locate payments.Following appropriate policy, update all system information toaccessible fields to include correct registration informat ion, address,telephone numbers, guarantor information, employer informat ion,insurance information, etc.Identify trends in system problems,traini ng or procedural concerns.Make recommendations and provide feedback rega rding corrective andpreventive action to the supervisor or manager. Trac k the problem toensure the inquiry is completed through PSC workfiles or the follow updatabase.Adhere to all HIPAA and confidentiality guideline s.Work with a diverse group of internal and external customers (i.e.atto rneys, insurance companies, state agencies, physician offices,collection agencies, etc).Work as ateam member towards common goals.Prepare and / or assist with special reports as requested by management.Adhereto a sch edule to ensure customer availability and demonstrateflexibility to sche dules according to patient or call volume or staffingneeds.Perform other related duties incidental to the work described herein.

Kno wledge, Skills and Abilities

Analytical and problem-solving skill sStrong organizational skills with the ability to multi-task and followt hrough on outstanding issuesStrong computer skills with knowledge of MS Word, MS Excel and e-mailExcellent interpersonal skills with the ability to communicateeffectively both orally and in writingAbility towork well with others - strong teamwork skillsMust be flexible and ableto functio n in awork environment where workand schedules may change tomeet the ne eds of the patientDemonstrated ability to work well with customers and d eliver excellentcustomer serviceAbility to control and manage a phone ca llBi-lingual preferredKnowledge 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.