Financial Care Specialist

5 days ago

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

Duke University Health System is seeking a highly skilled Financial Care Counselor to join our Patient Revenue Management Organization. As a key member of our team, you will play a critical role in ensuring the financial well-being of our patients and their families.

Job Summary:

The Financial Care Counselor will be responsible for accurately completing patient accounts based on departmental protocol, policies, and procedures, as well as ensuring compliance with regulatory agencies. This includes pre-admission, admission, pre-registration, and registration functions. You will also be responsible for ensuring all insurance requirements are met prior to patients' arrival and informing patients of their financial liability prior to arrival for services.

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 and visitors.
  • Explain policies and departmental coverage as requested.
  • Calculate and apply PRMO credit and collection policies.
  • Implement appropriate collection of 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 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 referrals 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.
  • 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.
  • None required.

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