Pocono Summit, Pennsylvania
Indianapolis, Indiana
Rockaway/NJ/USA
Salem, Virginia
Indianapolis, Indiana
Posted: 18-Nov-23
Location: Durham, North Carolina
Salary: Open
Categories:
Internal Number: 238675
Work Hours
Monday-Friday 7:30 a.m.-4 pm
Location: 10207 Cerney St. Raleigh, NC.
***$5000.00 Commitment Bonus (2 installments over 12 months in 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 sign-on bonus.
Occ Summary
Accurately complete patient accounts based on departmental protocol, policies, and procedures, and compliance with regular examination of insurance policies and other third-party sponsorship material from other agencies, to include but not be limited to pre-admission, admission, re-registration, and registration functions. Ensure all insurance requirements are met prior to patients' arrival, and inform patients of their financial liability prior to their 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 certifications 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 or payment. Admit, register, and pre-register patients with accurate patient demographic and financial data. Resolve insurance claim rejections or denials and remedy them expediently. Calculate and collect cash payments appropriately for all patients. Reconcile the 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 PRMOCR edit 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 in accordance with policy and procedure. for sources of payment. Inform the attending physician of the patient's financial health.
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. referees and provides assistance to visitors and patients. Explain policies to patients about the manufacturer's drug program as needed for medications. Gand processes and resolves problems. Gather the necessary documentation to support the proper handling of inquiries and complaints. Assist with departmental overage as requested. Obtain authorizations based on insurance plan regulations and guidelines. Document the billing system according to policy and procedure. Enter and update referrals as required. Communicate with insurance carriers regarding the requested clinical information and to resolve issues relating to coverage and payment.
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 Characteristics
The position responsible for high production generated accurately in accordance with established business processes or regulations requires working knowledge of compliance principles. The job offers the opportunity to work independently.
Minimum Qualifications
Education
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 businesses
Experience
Two years of experience working in hospital service access, clinical service access, the physician office, 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.
