Duke University and Duke University Health System require all students, faculty and staff to receive the COVID-19 and influenza vaccines. After you have officially accepted a position at Duke, you may request a religious or medical accommodation.PATIENT SERVICE REPRESENTATIVE - OUTPATIENT ELIGIBILITY/PROCEDURAL A
Requisition Number: 228774
Regular or Temporary: Regular
Durham, NC, US, 27710
Personnel Area: PRMO
Date: Feb 14, 2023
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.
Occupational Summary Work PerformedAnalyze insurance coverage and b enefits for service to ensure timelyrelationships with patients, physici ans, co- workers and supervisors.data, perform multiple tasks andservice- oriented workingwork independently. Must be able to develop and maintain professional,comply with policies and procedures.Must be able to unders tand anduninsured patients. Determine if patient's condition is the resu lt ofResponsible for accurate and complete patient accounts based ondepa rtmental protocol, policies andprocedures, and compliance with regulator y agencies, to include but notlimited to pre-admission,admission, pre-re gistration and registration functions. Ensure allinsurance requirements are met priorto patients' arrival, and inform patients of their financia l liability.Arranges payment options with thepatients and screens patien ts for government funding sources. This isposition has high customerserv ice with our payors and physicians by phone and requires excellentcustom er service skills. Thisposition is very similar to the Financial Care Co unselor. This positioncompletes all preliminary work.The Financial Couns elor completes the work when the patient arrives.reimbursement. Obtain a ll PACand/or authorizations as appropriate. Facilitate referral to Finan cialServices for payment sources foran accident, performing completerese arch to determine the appropriate source ofliability/payment.Schedules a nd pre-register patients,correcting as necessary all patient demographic and financial data.Resolve insurance claimrejections/denials and remedy expediently. Call patients to remind themto bring balances due, co-pays ,co insurance and deductible. Evaluate diagnoses to ensure compliancewit h the Local MedicareReview Policy. Perform those duties necessary to ens ure all accountsare processed accurately andefficiently. Promote and mai ntain excellence in customer service.Explain billing to patients accordi ng toPRMO credit and collection policies, when discussing insurance with patients. Implement appropriatecollection actions and assist financially responsible persons inarranging payment. Make referral toFinancial Serv ices Representative for counseling. Determine necessityof thirdparty sp onsorship andprocess patients per policy and procedure. Examine insuranc e policiesand other third partysponsorship materials for sources of paym ent. Inform attendingphysician of patient financial hardship.Update the billing system to reflect the insurance status of thepatient. Provides t imely and effectivecustomer service to internal customers. Assist with d epartmentalcoverage as requested. Obtainauthorizations based on insuranc e plan contracts / guidelines, documentin billing system per policyand p rocedure. Enter and update referralsas required. Communicate withinsura nce carriersregarding clinical information requested and to resolve issu es relatingto coverage and payment forspecific patients and benefits.Kno wledge Skills and AbilitiesExcellent communicationskills, oral and written. Ability to analyzeMinimum 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 business.Experience
Two to five years experience working in hospital access, physician office or billing and collections or an equivalent combination of relevanteducation and /or experienceDegrees, Licensures, Certifications
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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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