Financial Care Specialist

1 month ago

Durham, North Carolina, United States Duke University Full time
Job Title: Financial Care Counselor

At Duke University, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. Our Patient Revenue Management Organization is a fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle.

About the Role

We're seeking a Financial Care Counselor who will embrace our mission of Advancing Health Together. As a key member of our team, you will be responsible for accurately completing patient accounts based on departmental protocol, policies, and procedures, and compliance with regulatory agencies.

Key Responsibilities
  • Analyze insurance coverage and benefits for services to ensure timely payment.
  • Obtain authorizations based on insurance plan contracts and guidelines.
  • Document billing system and explain bills to patients.
  • Explain policies and departmental coverage as requested.
  • Calculate and apply PRMO credit and collection policies.
  • Implement appropriate cash payments for all patients.
  • Reconcile daily necessity of third-party sponsorship and process patients in accordance with 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 resolve problems.
  • Gather 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.
Requirements
  • Excellent communication skills, oral and written.
  • Ability to analyze relationships with patients, physicians, co-workers, and supervisors.
  • Must be able to develop and maintain professional, service-oriented working relationships.
  • Must be able to understand and comply with policies and procedures.
Level Characteristics
  • Position responsible for high production generated accurately in accordance with established business processes or regulation.
  • Requires working knowledge of compliance principles.
  • Job allows the opportunity to work independently.
MINIMUM QUALIFICATIONS

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 is required.

Two years of experience working in hospital service access, clinical service access, physician office, or billing and collections is required. Or, an Associate's degree in a healthcare-related field and one year of experience working with the public is required. Or, a Bachelor's degree and one year of experience working with the public is required.

Duke is an Affirmative Action/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, sexual orientation, or veteran 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.

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