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Patient Revenue Management Organization
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.
General Description of the Job Class
Answer and respond to all PRMO-related customer issues that are received by way of telephone and/or writing, meeting customer and departmental goals and objectives.
Duties and Responsibilities of this Level
Call Inquiries 80%
Answer and resolve all inbound inquiries and issues regarding patient account statements, bad debt write off's, explanation of benefits, balance due, and other patient and insurance billing related scenarios.
Analyze the patient's problem or issue that is presented by collecting information and data and conducting thorough research of the EPIC patient accounting systems, Hyland Onbase for documents that may have been imaged (EOB's, statements, admitting documentation, patient correspondence, etc.), RTE or BlueE for eligibility, researching payor websites and/or contacting the payor as needed. Analyze information for an appropriate solution and take the necessary action needed to resolve the issue.
Follow through on all customer issues promptly and accurately until completion. Document issues/ requests using the Customer Relation Manager (CRM), the customer service follow up database.
Thoroughly update and document notes or system comment fields with all information pertaining to an inquiry (i.e. questions, answers, actions, follow up items required).
Communicate with the patient, physicians, collection agency, internal departments and all other internal and external customers in a professional, courteous, and respectful manner.
Post customer service adjustments when supported by policy, contractual adjustments and other adjustments as deemed necessary following appropriate write off guidelines.
Update insurance information and file and/or appeal claims with insurance companies according to department guidelines. Take appropriate actions to bill insurance companies or patients with corrected information including accepting and inputting secondary insurance information into the system and filing claims.
Coordinate patient refund requests with the credit balance department. Research EOB's and payment detail to determine if a patient refund is necessary or determine the nature of the credit balance.
Provide financial counseling to patients, guarantors, and attorneys regarding charges for health care services. Validate that charges are correct and request medical review and audit when necessary
Discuss and establish payment plans for patients that require terms to pay off a balance.
General 10%
Produce itemized statements and mail to patients when requested.
Assist patients that are requesting charity care by completing a CRM with necessary information to determine financial assistance status. Provide feedback regarding status of the application when requested from a patient.
Obtain and post credit card payments for accounts within departmental guidelines. Follow department policy necessary for charge corrections, transferring credits, coding changes, service and charge disputes, and locate payments.
Following appropriate policy, update all system information to accessible fields to include correct registration information, address, telephone numbers, guarantor information, employer information, insurance information, etc.
Other 5%
Identify trends in system problems, training or procedural concerns. Make recommendations and provide feedback regarding preventive action to the supervisor or manager.
Adhere to all HIPAA and confidentiality guidelines.
Work with a diverse group of internal and external customers (i.e. attorneys, insurance companies, state agencies, physician offices, collection agencies, etc).
Work as a team member towards common goals.
Prepare and /or assist with special reports as requested by management.
Adhere to a schedule to ensure customer availability and demonstrate flexibility to schedules according to call volume or staffing needs.
5%
Perform other related duties incidental to the work described herein.
Degrees, Licensure,
and/or Certification: N/A
Knowledge, Skills,
and Abilities: Analytical and problem-solving skills
Strong organizational skills with the ability to multi-task and follow through on outstanding issues
Strong computer skills with knowledge of MS Word, MS Excel and e-mail
Excellent interpersonal skills with the ability to communicate effectively both orally and in writing
Ability to work well with others - strong teamwork skills
Must be flexible and able to function in a work environment where work and schedules may change to meet the needs of the patient
Demonstrated ability to work well with customers and deliver excellent customer service
Ability to control and manage a phone call
Bi-lingual preferred
Knowledge of DUHS billing preferred
Distinguishing Characteristics of this Level
N/A
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
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.
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.