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Financial Care Counselor

2 months ago

WinstonSalem, United States Duke University Health System Full time

JOB SUMMARY We are seeking a

Financial Care Counselor

to 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' arrival and inform patients of their financial liability before arrival for services. Arrange payment options with the patients and screen patients for government funding sources. JOB DUTIES AND RESPONSIBILITIES Analyze insurance coverage and benefits for service to ensure timely reimbursement. Obtain all Prior Authorization Certification 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. Enter and update referrals as required. Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment. Document billing system according to policy and procedure. Explain bills according to PRMO credit and collection policies. Adhere to PRMO Cash Management Policies and Procedures. 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 following 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. Explain policies and procedures and resolve problems. Gather necessary documentation to support the proper handling of inquiries and complaints. Greet and provide assistance to visitors. Check-in the patient upon arrival in the practice. Identify correct patient information in Maestro Care. Accurately identify the appropriate account for the patient visit. Present and educate patients on required forms and obtain signatures as required by policy and procedure. Complete all Maestro Care check-in files and manage all appropriate alerts. Imprint all patient-specific chart documents and requisition/transmittal documents. Copy, file, and distribute insurance cards as indicated by the procedure. Coordinate all labs/procedures as requested. Maintain private physician office charts. Check-out patients. Make return appointments by scheduling patients into the correct appointment type, entering the primary care physician or referring physician and scheduling tests and procedures. Answer the telephone, take and deliver messages to physicians, nurses, and others. Report obtained medical information from patients and referring physicians accurately, completely, and timely. Disseminate messages according to practice communication standards. Label and scan external documents into EMR. JOB ELIGIBILITY REQUIREMENTS 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 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. JOB HOURS The schedule for this position is day shifts, Monday-Friday, with no weekends or holidays. Duke Health Integrated Practice is dedicated to Equal Opportunity Employment, fostering a diverse workforce without regard to age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status. We aspire to build a community grounded in collaboration, innovation, creativity, and belonging. Our shared achievements rely on a dynamic exchange of ideas, flourishing best when a multitude of perspectives, backgrounds, and experiences thrive. Upholding these values is a collective responsibility within our community. This job description aims to outline representative responsibilities for this title, not an exhaustive account of specific duties. Employees may be assigned job-related tasks beyond those explicitly outlined here.

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