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.

***$2500.00 Sign On Bonus (2 installments over 12 months - 6-month increments) ***

Occ Summary

The Financial Care Counselor is an integral part of the patient care team in the clinic/service area and is responsible for the financial revenue cycle frontend-related activities - such as financial counseling and clearance of patients, authorizations, and referrals for procedures and services. ManyFinancial Care Counselors serve as Cash Managers in the clinic.  The Financial Care Counselor provides backup for the front desk registration activities.  The Financial Care Counselor is responsible for living Duke'svalues and demonstrating expected behaviors while contributing to creating a positive patient experience and building a positive work environment.  The Financial Care Counselor will maintain a professional image in appearance and over the phone.  The Financial Care Counselor contributes to ensuring the registration desk, Financial Care Counselor office and waiting areas safeguard patient privacy, confidentiality, and safety and are well-maintained and clean

 

 

Accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, including but not limited to pre-admission, admission, pre-registration, and registration functions. Ensure all insurance requirements are met before patients' arrival and inform patients of their financial availability before arrival for services. Arrange payment options with the patients and screen patients for government funding sources.

 

Work Performed

 

Analyze insurance coverage and benefits for service to ensure timely reimbursement. Obtain all Prior Authorization Certification and/or authorizations as appropriate. Facilitate payment sources for uninsured patients. Determine if the 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 and remedy expediently. Calculate and collect cash payments appropriately for all patients. Reconcile daily cash deposit. Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy. Perform those duties necessary to ensure all accounts are processed accurately and efficiently. Compile departmental statistics for budgetary and reporting purposes. Explain bills according to PRMO credit and collection policies.

 

Implement appropriate collection actions and assist financially responsible persons in arranging payment. Make a referral for financial counseling. Determine the necessity of third-party sponsorship and process patients by policy and procedure. Examine insurance policies and other third-party sponsorship materials for sources of payment. Inform the attending physician of the patient's 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 and assists visitors and patients. Explain policies and procedures, and resolves problems. Gathers necessary documentation to support the proper handling of inquiries and complaints. Assist with departmental l coverage as requested. Obtain authorizations based on insurance plans on tracts and guidelines. Document billing system according to policy and procedure. Enter and update referrals as required. Communicate with insurance carriers regarding clinical information requested and resolve issues relating to coverage and payment.

 

The FinancialCare Counselor is responsible for identifying and correcting insurance registration errors and contributing to the registration quality improvement. Many Financial Care Counselors serve as Cash Managers in the clinic. The TheFinancial Care counselor provides coverage at the front desk as required, TheFinancial Care Counselor maintains a professional image in appearance and over the phone. The Financial Care counselor safeguards patient privacy, confidentiality, and safety throughout all transactions. The Financial Care Counselor is responsible for living Duke's values by demonstrating expected behaviors, contributing to a positive patient experience, and building a positive work environment.

 

This position will primarily be responsible for the FCC functions supporting the DukeTriangle Endoscopy Center(DTEC) with insurance verification, patient estimates, financial counseling, and the FCC and claim edit work queues.

 

Patient identification and insurance verification

• Correctly identify the patient by checking an approved photo ID and utilizing a minimum of 2 approved patient identifiers. Follow Red Flag Procedure for patients unable to identify/verify
• Verify, capture/update complete demographic information for example, name, address, phone number, emergency contact, guarantor, race, ethnicity, veteran status, employer, and primary care provider information in Maestro Care as needed
• Respond to warnings, alerts, and confirmation checks presented; execute appropriate processes/corrections/updates to resolve.
• Verify, capture/update insurance information for example determine and select insurance carrier, enter subscriber information and plan information. Run RTE (Real Time Eligibility)for any updates or changes to insurance and verify benefits for reimbursement.
• Present and educate patients on financial, compliance, and authorization forms and obtain all necessary signatures as required per policy, for example, COA/COT, MSPQ, ABN, and self-administered Drugs.  Appropriately label, scan, and document the medical record for retention.
• Contract Risk Management/Workman's Compensation to coordinate billing/payment on accounts involving workers' compensation claims.
• Identify and collect patient financial liabilities (copay, coinsurance, deductibles, account balance); post appropriately based on payment type, payment amount, and method of payment.

           provide financial counseling to reach account resolution

• Provide financial counseling to patients and their families regarding outstanding patient liability, co-pays, deductibles, coinsurance, and (self-pay) balances for healthcare services.
• Create estimates and call patients 1 week before their scheduled appointment making them aware of their out-of-pocket liability. Attempt to collect before the visit if possible.
• Explain Duke'sFinancial Assistance and billing policies to patients and their guarantors.
• Explain billing and insurance implications for provider and hospital-based clinics to include the patient's responsibility for co-insurance and copay and the potential for multiple bills.  Address all questions and concerns; appropriately refer to FCC or customer service if PSA is unable to answer the questions.
• Evaluatepatient/guarantor assets and liabilities to determine the ability to pay for services.
• Estimate/determine fees for services and assist patients and families with payment options.
• Determine the necessity of third-party sponsorship and process patients per policy and procedure. Examine insurance policies and other third-party sponsorship materials for sources of payment

 

 

• Implement appropriate collection actions and assist ts financially responsible persons in arranging payment.
• Evaluate patient requests for charity care or other medical assistance programs, identify funding sources, and refer to the appropriate group if necessary (MAC team, Customer Service, etc.).
• Inform the attending physician of the patient's financial hardship and need for interpreter services.
• Follow Financial Pathway guidelines when scheduling (Out of network, self-pay, Out of county self-pay, and Medicaid) ensuring patient education for financial responsibility and payment expectations.
• Counsel patients and complete the managed care waiver form for patients enrolled in a non-contracted health plan (out of network) and receiving services at a reduced benefit level. Collect payment upfront for services per policy.
• Refer patients to Manufacturer Drug Programs/Pharmacy assistance programs as needed for medications as appropriate.

 

Cash Management

• Obtain a cash bag at the beginning of the shift. Complete imprest cash bag logs, void refund logs, and receipt book logs (as needed) to meet internal control standards.
• Request payment on patient liability per policy.

 

• Request deposit for confirmed self-pay visits per policy.
• Ensure that the patient receives financial counseling if necessary, based on the ability to pay and account status flags.
• Balance cash, check, and credit card collections at the end of each day; reconcile discrepancies and prepare personal deposits for the cash manager according to cash management policies.
• Meet Private Card Industry standards by securing cash and credit card receipts at all times during clinic hours, following policy for obtaining and return of cash bags on daily basis.

 

Customer Service, Safety, and Work Culture

• Interact with patients, visitors, and staff professionally at all times.  Be available and greet patients and visitors immediately upon presentation.
• Inform clinical staff of late arrivals and identify appropriate action (for example arrive and reschedule if necessary). Perform service recovery.
• Consistently use "Words that Work" and RELATE in daily interactions with patients, their loved ones, and each other.
• Provide directions, arrange for patient transport, and interpreters if necessary.
• Achieve or Exceed patient experience expectations, consistently use "Words that Work" and "RELATE" in daily interactions with patients.
• Contribute to a positive work environment by living Duke's values and demonstrating expected behaviors.
• Report safety issues of themselves and others promptly to clinic leadership and report personal safety incidents or concerns within 24 hours of occurrence.
• Identify operational improvements to maximize the efficiency and effectiveness of services provided. Communicate opportunities to management.

 

 

Pre-Determination/Pre-authorization/authorization/Referrals

 

• Obtain authorizations based on insurance plan contracts/guidelines, and documents in the Maestro Care system per policy and procedure.

 

Knowledge, Skills, and Abilities

 

Excellent communication skills, oral and written. Ability to analyze data, perform multiple tasks and work independently. Must be able to develop and maintain professional, service-oriented working relationships with patients, physicians, co-workers, and supervisors.Must be able to understand and comply with policies and procedures.

 

Level Ch characteristics

 

Position responsible for high production generated accurately by established business processes or regulations. Requires working knowledge of compliance principles. The job allows the opportunity to work independently.

 

Minimum Qualifications

 

 

Education

Work requires knowledge of basic grammar and mathematical principles normally required through high school education, with some post-secondary education preferred. Additional training or working knowledge of related business.

 

Experience

 

Two years experience working in hospital service access, clinical service access, physician office, or billing and collections. Or, 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.

 

Degrees, Licensures, Certifications

 

None required

 

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.

 

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