Financial Care Counselor - Duke Pain Medicine Clinic

Financial Care Counselor Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Financial Care Counselor who will embrace our mission of Advancing Health Together. 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 services to ensure timely processing. Obtain authorization‑based payment on insurance plan contracts and guidelines. Document billing system. Explain bills and provide assistance to visitors and patients. Explain policies and departmental coverage as requested. Calculate and apply PRMO credit and collection policies. Collect cash payments appropriately for all patients. Reconcile daily third‑party sponsorship and process patients in accordance with reimbursement. Obtain all Prior Authorization certifications and/or authorizations as appropriate. Facilitate payment sources for uninsured patients. Determine if a patient's condition is the result of an accident and perform research to determine 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. Initiate collection actions and assist financially responsible persons in arranging payment. Make referrals for financial counseling. Determine actions according to 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 patients, resolve problems and procedures. 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 to resolve issues relating to coverage. Knowledge, Skills and Abilities Excellent communication skills, oral and written. Ability to analyze relationships with patients, physicians, co‑workers and supervisors; maintain data, perform multiple tasks, and work independently. Develop and maintain professional, service‑oriented working relationships. 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; 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 post‑secondary 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 Employment Opportunity Statement 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. #J-18808-Ljbffr Independent Educational Consultants Association