Patient Account Associate - Special Programs: Vendors - Remote - MUST RESIDE IN NC

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.

REMOTE POSITION: Monday - Friday

General Description of the Job Class

Record and generate variety of information pertaining to the patient revenue process. Accurate, high-performance level position requires certain degree of knowledge of complex rules and corresponding ability to apply these rules in the work environment to achieve desired outcomes.

Duties and Responsibilities of this Level:

Workload 85%

Fiscal Responsibility: Record or generate revenue by gathering and processing information that impacts the patient revenue process. Fiscal responsibility measured on high production levels, quality of work output, in compliance with established DUHS policy standards. May also be defined in terms of value of work portfolio assigned and /or revenue expectations.

• Review and resolve AR associated with all payors.
• Works closely with vendors, Payor Relations and other operational areas for resolution of outstanding AR.
• Updates registration for patients when working registration related denials.
• Review payor websites for claim status information on outstanding AR or pending appeals/med doc submissions.
• Resolve AR associated with denials from payors and resolve per payor requests and guidelines.
• Review and resolve AR related to vendor question workqueues and provide appropriate responses for resolution.
• Provide support to all books of business within the department that includes claim edits, claim denials, insurance follow up and claim statusing.
• Achieve 100% of projected cash collections for PDC and DPC.
• Maintain a DRO of 35-40 days for PDC and 25-30 for DPC.
• Reduce PDC Insurance A/R >150 days to less than 10%.
• Reduce overall PDC denial rate for billing to <3% and registration to <1.25%.
• Maintain passing score for internal control quarterly audits.
• Maintain work queues at less than one week of inventory without loss to timely filing.
• Limited amount of transfers to other work queues.
• Makes independent decisions for accurate outcome of working claim edits, denials, no response follow up and correspondence documentation.
• Adhere to all PRMO and DUHS revenue cycle policies and regulations.
• Respect and maintain confidentiality regarding patient/ guarantor financial data and patient medical data consistent with HIPAA standards.
• Clearly document write-off requests per policy with appropriate paycode.
• Adheres to DUHS badge swiping and time and attendance policies.
• Turns in weekly Productivity Time Tracking Sheet in an accurate and timely fashion.
• Maintain non-productive time at less than 4% for the reporting period.
• Make process improvement suggestions to Management for daily tasks, in an effort to reduce inventory at a faster rate.
• Demonstrates the ability to use time management and organizational skills to keep A/R thresholds at an exceeds level.
• Proactively reports trends and system related problems to Management as soon as it is first noticed.

Workload 5%

Customer Service: Initiate and develop relationships with customers in order to gather and process information or resolve issues in order to receive accurate reimbursement and optimize internal and external customer satisfaction.

• Consistently responds to issues within two business days.
• Consistently respond to Supervisor/Team/Customer inquiries, providing appropriate feedback; alleviating the need for unnecessary follow up.
• Consistently demonstrates the ability to accept change within the team and department.
• Maintains minimal use of company phones, internet and e-mail for personal usage within our policies and procedures.
• In caring for our patients, loved ones and each other maintain strict confidentiality of patient medical and financial records.
• Initiate and develop relationships with customers in order to gather and process information or resolve issues in order to receive accurate reimbursement and optimize internal and external customer satisfaction.
• Remain in satisfactory compliance with all existing policies and procedures.
• Maintain timely completion of the hyland workflow process and hyland medical records.
• Attends meetings and participates on committees, as assigned.
• Work with other PRMO Supervisors to improve collections, reduce accounts receivable, reduce denial rates, and reduce avoidable write-offs through issue identification, research, communication, and process improvement
• Provide cross-coverage where support is needed
• Volunteers to participate on committees to enhance customer focus.
• Participates in cross-department initiatives and projects.
• Responds to customers in less than one business day.
• Receives positive feedback/acknowledgement from internal and external customers.
• Identify significant customer service improvements.
• Always goes above and beyond to provide detailed/accurate feedback when replying to inquiries.
• Always follows up with customers to ensure needs are being met.

Workload 10%

Clerical, Clinical, Work Culture Duties: Operate general office equipment. Generates letters, works on spreadsheets; enters and sorts data.

• Attend and participate in meetings.
• Actively participates in departmental events.
• Supportive of a positive team environment, through offering solutions to work related concerns and referring teammates to management when an issue can’t easily be resolved.
• Exhibit appropriate engagement in all that we do.
• Maintain good attendance and dependability in accordance with Availability to Work Policy.
• Engage in frequent rounding conversations with all Management.
• Complete all safety training prior to yearly renewal date/month.
• Comply with required on-line safety training to include LMS.
• Actively participate in Work Culture initiatives based off of annual work culture scores and action plans.
• Complete all annual online training prior to notification and without reminders from Management.
• No more than one unscheduled occurrence/tardy in review period.
• Exemplary support of other team involvement and workflow needs from internal and external customers.
• Engage in training and development via internal/external sources during the review period.
• Is a leader in participation and promotion of a positive work culture.
• Exemplary rounding participation.

Scope of Authority: Work independently and has the ability to make decisions relative to individual work activities. Accountable for individual work activities. Work assignments defined by immediate supervisor or manager. Job does not require supervision of other employees in the unit.

Required Qualifications at this Level

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

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Experience: Two years experience working in hospital access, physician office or billing and collections or an equivalent combination of relevant education and/or experience.

Degrees, Licensure, and/or Certification: N/A

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.

Distinguishing Characteristics of this Level

N/A

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.

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.