PATIENT SERVICE REPRESENTATIVE - OUTPATIENT ELIGIBILITY/PROCEDURAL A
Duke University Health System
Location: Durham, North Carolina
Internal Number: 209244
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 Dukeâ€™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.
Responsible for accurate and complete patient ac counts based ondepartmental protocol, policies and procedures, and compl iance withregulatory agencies, to include but not limited to pre-admissi on,admission, pre-registration andregistration functions. Ensure allins urance requirements are met prior to patients' arrival, and informpatien ts of their financial liability. Arranges payment options withthe patien ts and screens patients for government funding sources. Thisis position has high customer service with our payors and physicians byphone and req uires excellent customer service skills. This position isvery similar to the Financial Care Counselor. This position completesall preliminary wo rk. The Financial Counselor completes the work whenthe patient arrives.< /p>
Analyze insurance coverage and benefi ts for service to ensure timelyreimbursement. Obtain all PAC and/or auth orizations as appropriate.Facilitate referral to Financial Services forpayment sources foruninsured patients. Determine if patient's condition is the result ofan accident, performing complete research to determine t he appropriatesource of liability/payment. Schedules and pre-register pa tients,correcting as necessary all patient demographic and financial dat a.Resolveinsurance claim rejections/denials and remedy expediently. Cal lpatients to remind them to bring balances due, co-pays, co insuranceand deductible. Evaluate diagnoses to ensure compliance with the LocalMedic are Review Policy. Perform those duties necessary to ensure allaccounts are processed accurately and efficiently. Promote and maintainexcellence in customer service.Explain billing to patientsaccording to PRMO credit and collection policies, when discussinginsurance with patients. Implem ent appropriate collection actions andassist financially responsible per sons in arranging payment. Makereferral to Financial Services Representa tive for counseling.Determine necessity of third party sponsorship and p rocess patients perpolicy and procedure. Examine insurance policies and other third partysponsorship materials for sources of payment. Inform at tendingphysician of patient financialhardship. Update the billing syste m toreflect the insurance status of the patient.Provides timely andeffec tive customer service to internal customers. Assist withdepartmental cov erage as requested.Obtain authorizations basedon insurance plan contract s / guidelines, document in billing systemper policy and procedure. Ente r and update referrals as required.Communicate with insurance carriers r egarding clinical informationrequested and to resolve issues relating to coverage and payment forspecific patients and benefits.
Kno wledge, Skills and Abilities
Excellent communication skills, ora l and written. Ability to analyzedata, perform multiple tasks and work i ndependently. Must be able todevelop and maintain professional, service- oriented workingrelationships with patients, physicians, co-workers and supervisors.Must beable to understand and comply with policies and proc edures.
Work requires knowledge of basic grammar and mathematical principles normally required through a high school education, with some postsecondary education preferred. Additional training or working knowledge of related business.
Two to five years experience working in hospital access, physician office or billing and collections or an equivalent combination of relevant education and /or experience
Degrees, Licensures, Certifications
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.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.