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Duke University Health System · 1 month ago

Financial Care Counselor - DRH HSC

Durham, NC

Full-time

Onsite

Entry, Mid Level

2+ years exp

Duke University Health System is committed to compassionate care and is seeking a Financial Care Counselor to support its Patient Revenue Management Organization. The role involves managing patient accounts, ensuring insurance compliance, and facilitating payment options for patients.

Health CareMedical

Responsibilities

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 screens patients for government funding sources

Analyze insurance coverage and benefits for service to ensure timely reimbursement

Obtain all Prior Authorization Certification and/or authorizations as appropriate

Facilitate payment sources for uninsured patients

Determine if patient's condition is the result of an accident and perform complete 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

Calculate and collect cash payments appropriately for all patients

Reconcile daily cash deposit

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

Explain bills according to PRMO credit and collection policies

Implement appropriate collection actions and assist financially responsible persons in arranging payment

Make referral for financial counseling

Determine necessity of third party sponsorship and process patients in accordance with 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 and provides assistance to visitors and patients

Explain policies and procedures, and resolves problems

Gathers necessary documentation to support proper handling of inquiries and complaints

Assist with departmental coverage as requested

Obtain authorizations based on insurance plan contracts and guidelines

Document billing system 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 and payment

Qualification

Insurance analysisPatient registrationBillingCollectionsData analysisCommunication skillsMathematical principlesService-oriented relationshipsCompliance knowledge