Financial Care Counselor - DRH Outpatient

Duke Careers • Durham, NC

8d • Onsite

About The Position

Duke Regional Hospital Outpatient is seeking a Financial Care Counselor to join the Patient Revenue Management Organization (PRMO). This role is responsible for accurately completing patient accounts according to departmental protocols, policies, and procedures, ensuring compliance with regulatory agencies. The Financial Care Counselor will verify insurance requirements, inform patients of their financial liability, arrange payment options, and screen patients for government funding sources. This position is crucial in streamlining the revenue cycle for Duke Health, supporting functions such as scheduling, registration, coding, and billing.

Requirements

• 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.
• 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.
• 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.

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 but not limited to pre-admission, admission, pre-registration and registration functions.
• Ensure all insurance requirements are met prior to patients' arrivals and inform patients of their financial liability prior to arrival for services.
• Arrange payment options with the patients and screens patients for government funding sources.
• Analyze insurance coverage and benefits for service to ensure timely.
• Obtain authorizations based payment on insurance plan contracts and guidelines.
• Document billing system.
• Explain bills provides assistance to visitors and patients.
• Explain policies and departmental coverage as requested.
• Calculate and according to PRMO credit and collection policies.
• Implement appropriate collect cash payments appropriately for all patients.
• Reconcile daily necessity of third party sponsorship and process patients in accordance reimbursement.
• Obtain all Prior Authorization Certification and/or authorizations as appropriate.
• Facilitate payment sources for uninsured patients.
• Determine if 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.
• 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.
• Collection actions and assist financially responsible persons in arranging payment.
• Make referral for financial counseling.
• Determine with policy and procedure.
• Examine insurance policies and other third party sponsorship materials for sources of payment.
• Inform 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 procedures, and resolves problems.
• Gathers necessary documentation to support proper handling of inquiries and complaints.
• Assist with 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.

Benefits

• $5000.00 DUHS Commitment Bonus Program (paid in 2 installments over 12 months - 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 commitment bonus.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED