FINANCIAL CARE COUNSELOR

Duke Careers•Durham, NC

1d•Onsite

About The Position

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. The Patient Revenue Management Organization (PRMO) is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle, including scheduling, registration, coding, billing, and other essential revenue functions for Duke Health. The Financial Care Counselor is responsible for accurately completing patient accounts based on departmental protocol, policies, and procedures, and in compliance with regulatory agencies. This includes pre-admission, admission, pre-registration, and registration functions. The role ensures all insurance requirements are met prior to patients' arrival, informs patients of their financial liability, arranges payment options, and screens patients for government funding sources.

Requirements

Work requires knowledge of basic grammar and mathematical principles normally required through a high school education.
Additional training or working knowledge of related business.
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.
Excellent communication skills, oral and written.
Ability to analyze data.
Ability to 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.
Working knowledge of compliance principles.

Nice To Haves

Some postsecondary education preferred.

Responsibilities

Accurately complete patient accounts based on departmental protocol, policies, and procedures and compliance with regulatory agencies, to include pre-admission, admission, pre-registration and registration functions.
Ensure all insurance requirements are met prior to patients' arrival.
Inform patients of their financial liability prior to arrival for services.
Arrange payment options with the patients.
Screen patients for government funding sources.
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/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 patient 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 provide assistance to visitors and patients.
Explain policies and procedures and resolve problems.
Gather 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 the 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.