FINANCIAL CARE COUNSELOR

Occ Summary Accurately complete patient accounts based on departmental protocol, policies, and procedures and compliance with regulatory agencies, to include but not be 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 prior to arrival for services. Arrange payment options with the patients and screen patients for government funding sources. Work Performed Analyze insurance coverage and benefits for services to ensure timely reimbursement. Obtain all prior authorization certifications 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 them expediently. Calculate and collect cash payments appropriately for all patients. Reconcile the daily cash deposit. 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. Explain bills according to PRMO credit and collection policies. 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 in accordance with 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. Greet and provide assistance to visitors and patients. Explain policies and procedures and resolve problems. Gather necessary documentation to support proper handling of inquiries and complaints. Assist with departmental coverage as requested. Obtain authorizations based on insurance plan contracts and guidelines. Document the billing system according to policy and procedure. Enter and update referrals as required. Communicate with insurance carriers regarding clinical information requested and resolve issues relating to coverage and payment. Knowledge, Skills and Abilities Excellent communication skills, oral and written. Ability to analyze data, perform multiple tasks and work independently. Must be able to develop and maintain professional, service‑oriented working relationships with patients, physicians, co‑workers and supervisors. 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 regulations. Requires working knowledge of compliance principles. The job allows the opportunity to work independently. Minimum Qualifications Education 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. Experience 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. Degrees, Licensures, Certifications None required Equal Opportunity Employer 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. Commitment to Diversity and Inclusion 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. Nearest Major Market Durham Nearest Secondary Market Raleigh Affirmative Action and Nondiscrimination Read more about Duke’s commitment to affirmative action and nondiscrimination at hr.duke.edu/eeo. #J-18808-Ljbffr Duke PF