Financial Care Specialist

2 months ago

Durham, North Carolina, United States Duke University Full time
About the Role

We are seeking a highly skilled and detail-oriented Financial Care Specialist to join our team at Duke University. As a key member of our Patient Revenue Management Organization, you will play a critical role in ensuring the accurate and efficient processing of patient accounts.

Key Responsibilities
  • Analyze insurance coverage and benefits to ensure timely reimbursement
  • Obtain prior authorization certifications and authorizations as necessary
  • Facilitate payment sources for uninsured patients
  • Determine liability/payment sources for patients with accident-related conditions
  • Admit, register, and pre-register patients with accurate demographic and financial data
  • Resolve insurance claim rejections and denials in a timely manner
  • Calculate and collect cash payments from patients
  • Reconcile daily cash deposits
  • Evaluate diagnoses to ensure compliance with Local Medicare Review Policy
  • Compile departmental statistics for budgetary and reporting purposes
  • Explain bills to patients according to PRMO credit and collection policies
  • Implement collection actions and assist financially responsible individuals in arranging payment
  • Make referrals for financial counseling as needed
  • Determine necessity of third-party sponsorship and process patients accordingly
  • Examine insurance policies and other third-party sponsorship materials for sources of payment
  • Inform attending physicians of patient financial hardship
  • Complete managed care waiver forms for patients receiving services at a reduced benefit level
  • Update the billing system to reflect patient insurance status
  • Refer patients to the Manufacturer Drug program as necessary
  • Provide assistance to visitors and patients, explaining policies and procedures and resolving problems
  • Gather necessary documentation to support proper handling of inquiries and complaints
  • Assist with departmental coverage as requested
  • Communicate with insurance carriers regarding clinical information and coverage/payment issues
Requirements
  • Excellent communication skills, both oral and written
  • Ability to analyze data, perform multiple tasks, and work independently
  • Develop and maintain professional, service-oriented working relationships with patients, physicians, co-workers, and supervisors
  • Understand and comply with policies and procedures
Preferred Qualifications
  • Two years of experience working in hospital service access, clinical service access, physician office, or billing and collections
  • Associate's degree in a healthcare-related field and one year of experience working with the public
  • Bachelor's degree and one year of experience working with the public

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