FINANCIAL CARE COUNSELOR

Duke PA; Durham (NC); On-site; USD 42,000 - 64,000; Full time

Job summary

Duke Health in Durham, NC seeks a Billing Specialist to support the Patient Revenue Management Organization (PRMO). You will finalize patient accounts, assess coverage, and secure necessary authorizations to optimize reimbursement.

Strong communication and data-analysis skills are required. You will join a team focused on accurate billing, responsive patient service, and compliant revenue-cycle operations in a high-volume setting.

Qualifications

• High school education normally required; some postsecondary education preferred.
• Two years of experience in hospital service access, clinical service access, physician office, or billing and collections.
• Explain bills and inform patients of financial liability per policies.

Responsibilities

• Accurately complete patient accounts per departmental protocol and regulatory requirements.
• Analyze insurance coverage and benefits for timely reimbursement.
• Obtain prior authorization certifications and/or authorizations as appropriate.
• Explain bills according to PRMO credit and collection policies.

Skills

Communication skills

Data analysis

Multitasking

Independent work

Education

High school education

Some postsecondary education

Tools

Billing software

Billing systems

Insurance platforms

Job description

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At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.

Occ Summary

Accurately complete patient accounts based on departmental protocol, policies, and procedures and compliance with regulatory agencies, to include but not be limited to pre-admission, admission, pre-registration, and registration functions. Ensure all insurance requirements are met prior to patients' arrival and inform patients of their financial liability prior to 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 sourcesfor 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 in accordance with 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\'s drug program as needed for medications. Greets and provides assistance to visitors and patients. Explains policies and procedures and resolves problems. Gathers necessary documentation to support proper handling of inquiries and complaints. Assist with departmental coverage as requested. Obtain authorizations based on insurance plan contracts 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 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

Position responsible for high production generated accurately in accordance with 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 a high school education, with some postsecondary education preferred. Additional training or working knowledge of related business.

Experience

Two years of 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 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 (including pregnancy and pregnancy related conditions), sexual orientation or military 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.

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 essential job 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.

Nearest Major Market: Durham

Nearest Secondary Market: Raleigh

Read more about Duke’s commitment to affirmative action and nondiscrimination at hr.duke.edu/eeo.