Duke University Health System · 1 hour ago
Patient Service Representative - Authorization Denial Team
Durham, NC
Full-time
Hybrid
Entry, Mid Level
2+ years expDuke University Health System is committed to compassionate care and is seeking a Patient Service Representative for their Patient Revenue Management Organization. The role involves managing patient accounts, ensuring insurance compliance, and providing excellent customer service.
Health CareMedical
Responsibilities
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
Arranges 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 PAC and/or authorizations as appropriate
Facilitate referral to Financial Services for payment sources for uninsured patients
Determine if patient's condition is the result of an accident, performing complete research to determine the appropriate source of liability/payment
Schedules and pre-register patients, correcting as necessary all patient demographic and financial data
Resolve insurance claim rejections/denials and remedy expediently
Call patients to remind them to bring balances due, co-pays, co insurance and deductible
Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy
Perform those duties necessary to ensure all accounts are processed accurately and efficiently
Promote and maintain excellence in customer service
Explain billing to patients according to PRMO credit and collection policies, when discussing insurance with patients
Implement appropriate collection actions and assist financially responsible persons in arranging payment
Make referral to Financial Services Representative for counseling
Determine necessity of third party sponsorship and process patients per policy and procedure
Examine insurance policies and other third party sponsorship materials for sources of payment
Inform attending physician of patient financial hardship
Update the billing system to reflect the insurance status of the patient
Provides timely and effective customer service to internal customers
Assist with departmental coverage as requested
Obtain authorizations based on insurance plan contracts/guidelines, document in billing system per 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 for specific patients and benefits
Qualification
Required
Work requires knowledge of basic grammar and mathematical principles normally required through a high school education, with some postsecondary education preferred
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
Excellent communication skills, oral and written
Ability to analyze data, perform multiple tasks and work independently
Must be able to develop and maintain professional, service-oriented working relationships with patients, physicians, co-workers and supervisors
Must be able to understand and comply with policies and procedures
Preferred
ARIA or Radiation Oncology experience preferred
Hyland (Imaging Solution) preferred
Payer Portals preferred
Epic preferred
Company
Duke University Health System
World-class academic and health care system
10001+ employees
H1B Sponsorship
Duke University Health System has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (39)
2024 (30)
2023 (17)
2022 (24)
2021 (12)
2020 (10)
Funding
Current Stage
Late StageLeadership Team
Chernelle Jones
Special Events Coordinator for: Exec. Vice Pres. Health Affairs, CEO of DUHS, & Dean, School of Med.
Dan Bruno
Chief of Staff and Chief Operating Officer, Duke Health Technology Solutions
Recent News
The Philadelphia Inquirer
2025-11-27
2025-10-09
2025-10-02
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