Patient Service Representative - Authorization Denial Team

Overview

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.

Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Patient Service Representattive who will embrace our mission of Advancing Health Together.

Work Hours: Monday - Friday 8:00 - 4:30 (No weekends or Holidays)

Hybrid remote position: working between 1-2 days in office a week depending on the needs of the department. Location in office is 12 Moore Drive, Durham, NC 27713.

• Responsible for accurate and 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.
• Arrange payment options with the patients and screen patients for government funding sources.
• Maintain high customer service with payors and physicians by phone; provide excellent customer service.
• Perform preliminary work; the Financial Counselor completes the work when the patient arrives.
• Analyze insurance coverage and benefits for service to ensure timely reimbursement; obtain authorizations as appropriate.
• Facilitate referral to Financial Services for payment sources for uninsured patients.
• Determine liability/payment sources, schedule and pre-register patients, and correct demographic and financial data as needed.
• Resolve insurance claim rejections/denials and remedy expediently.
• Call patients to remind them to bring balances due, co-pays, co-insurance and deductible.
• Explain billing to patients according to PRMO credit and collection policies; implement appropriate collection actions.
• Assist financially responsible persons in arranging payment; make referrals to Financial Services Representative for counseling.
• Update the billing system to reflect the insurance status of the patient; communicate with insurance carriers regarding coverage and payment issues.
• Provide timely and effective customer service to internal customers; assist with departmental coverage as requested.
• Obtain authorizations based on insurance plan contracts/guidelines and document in billing system per policy and procedure.
• Enter and update referrals as required.
• Determine necessity of third-party sponsorship and process patients per policy and procedure.

• Excellent communication skills, oral and written.
• Ability to analyze data, perform multiple tasks and work independently.
• Ability to develop and maintain professional, service-oriented working relationships with patients, physicians, co-workers and supervisors.
• Ability to understand and comply with policies and procedures.

• 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 to five years experience working in hospital access, physician office or billing and collections or an equivalent combination of relevant education and/or experience.

• ARIA or Radiation Oncology experience preferred
• Hyland (Imaging Solution) preferred
• Payer Portals preferred
• Epic preferred

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.

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…