Financial Care Counselor - Duke Pain Medicine Clinic

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 The Patient Revenue Management Organization 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. Duke Pain Medicine Clinic Financial Care Counselor Work hours: Monday - Friday, 8:00am - 4:30pm DUHS Commitment Bonus Program: $5,000.00 (paid in 2 installments over 12 months – 6‑month increments). Only new hires who have not worked for Duke University in the past 12 months are eligible. Job Summary Accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, to include but not 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 service to ensure timely settlement. Obtain authorizations based on payment on insurance plan contracts and guidelines. Document billing system entries. Explain bills and provide assistance to visitors and patients. Explain policies and departmental coverage as requested. Calculate debt according to PRMO credit and collection policies. Implement appropriate collection of cash payments for all patients. Reconcile daily third‑party sponsorship and process patient reimbursements. Obtain all Prior Authorization certifications and/or authorizations as appropriate. Facilitate payment sources for uninsured patients. Determine if a patients condition is the result of an accident and perform 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. Perform collection actions and assist financially responsible persons in arranging payment. Make referral for financial counseling. Determine policy and procedure applicability. Examine insurance policies and other third‑party sponsorship materials for payment sources. Inform attending physician of patient financial hardship. Complete the managed care waiver form for out‑of‑network patients receiving reduced benefit level services. Update the billing system to reflect the insurance status of the patient. Refer patients to the Manufacturer Drug program as needed for medications. Greet patients and resolve problems. Gather necessary documentation to support proper handling of inquiries and complaints. Assist according to policy and procedure. Enter and update referrals as required. Communicate with insurance carriers regarding clinical information requested and resolve coverage issues. Knowledge, Skills and Abilities Excellent communication skills, oral and written. Ability to analyze relationships with patients, physicians, co‑workers and supervisors. Perform multiple tasks and work independently. Ability to develop and maintain professional, service‑oriented working relationships. Understanding and compliance 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 Education Basic grammar and mathematical principles normally required through a high school education, with some post‑secondary education preferred. Additional training or working knowledge of related business. Experience 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. Degrees, Licensures, Certifications None required. E‑Equal Opportunity Employment 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. 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. #J-18808-Ljbffr Duke University Health System