Financial Care Counselor - Orthopaedics Apex

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 supporting the entire health system in streamlining the revenue cycle, including scheduling, registration, coding, billing, and other essential revenue functions for Duke Health. On‑site Position Monday - Friday (7:30 AM - 4:30 PM) Occ Summary Accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies. Tasks include 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 for services. Arrange payment options and screen patients for government funding sources. Work Performed Analyze insurance coverage and benefits to ensure timely reimbursement. Obtain prior authorization certifications and authorizations as appropriate. Facilitate payment sources for uninsured patients. Determine if patient's condition is due to an accident and research liability/payment sources. Admit, register, and pre‑register patients with accurate patient demographic and financial data. Resolve insurance claim rejections/denials and remedy expediently. Calculate and collect cash payments, reconcile daily cash deposits. Evaluate diagnoses to ensure compliance with Local Medicare Review Policy. Perform duties necessary to ensure all accounts are processed accurately and efficiently. Compile departmental statistics for budgetary and reporting purposes. Explain bills per PRMO credit and collection policies; implement appropriate collection actions. Assist financially responsible persons in arranging payment and refer for financial counseling. Determine necessity of third‑party sponsorship and process patients accordingly. Examine third‑party sponsorship materials for payment sources. Inform attending physician of patient financial hardship. Complete managed care waiver form for out‑of‑network patients. Update the billing system to reflect insurance status. Refer patients to Manufacturer Drug program as needed. Greet and assist visitors and patients; explain policies and procedures; resolve problems. Gather documentation to support handling inquiries and complaints. Assist with departmental coverage as requested. Document billing system per policy and procedure. Enter and update referrals as required. Communicate with insurance carriers regarding coverage and payment issues. Knowledge, Skills and Abilities Excellent oral and written communication skills; ability to analyze data, perform multiple tasks, work independently, develop and maintain professional, service‑oriented relationships with patients, physicians, co‑workers and supervisors; 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 knowledge of compliance principles; opportunity to work independently. Minimum Qualifications High‑school level education or equivalent. Postsecondary education preferred. Two years’ experience in hospital service access, clinical service access, physician office or billing and collections; or Associate’s degree with one year public‑facing experience; or Bachelor’s degree with one year public‑facing experience. No specific degrees, licenses, or certifications required. Essential Physical Job Functions Some duties may require specific physical and/or mental abilities. Information about reasonable accommodation available upon request. 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 Duke University Health System