PRMO Established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke Primary Care. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Dukeâ€™s reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.
****$2500 Sign Bonus (2 installments over 12 months-6 month increments)****
Work Hours (Friday, Saturday, and Sunday; 7 p.m.-7:30 a.m.)
Ability to analyze insurance coverage, benefits, third-party liabilities, and patient liabilities for service to ensure timely payment. The position is responsible for high production generated accurately. Accurately complete patient accounts based on the departmental protocol, greet and assists visitors and patients. Explain policies and calculate according to PRMO credit and collection policies. Implement appropriate insurance plan contracts and guidelines. Document billing system, explain bills with patients, coverage, and medications policies and procedures, considered out-of-network and receiving services at a reduced benefit, and compliance with regulatory agencies, including but not limited to pre-admission, admission, pre-registration, and registration functions. Ensure all insurance requirements are met before patients' arrival and inform patients of their financial liability before arrival for services.
Arrange payment options with the patients and screen patients for government funding sources department tal coverage and collect cash payments appropriately for all patients. Reconcile daily necessity of third-party sponsorship and process patients in accordance-reimbursement. Obtain all Prior Authorization Certification and/or authorizations as appropriate. Facilitate payment sources for uninsured patients. Determine if the 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 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 reporting purposes and collection actions and assist financially responsible persons in arranging payment. Make a referral for financial counseling. Determine with policy and procedure. Examine insurance policies and other third-party sponsorship materials for sources of payment. Inform the attending physician of the patient's financial hardship. Complete the managed care waiver form for the patient's level. Update the billing system to reflect the insurance status of the patient. Refer patients to the Manufacturer Drug program as needed for procedures and resolves problems.
Gathers necessary documentation to support the proper handling of inquiries and complaints. Assist with according to policy and procedure. Enter and update referrals as required. Communicate with insurance carriers regarding clinical information requested and resolve issues relating to physicians, co-workers, and supervisors. data, perform multiple tasks, and work independently. Must be able to de velop and maintain professional, service-oriented working and must be able to understand and comply with policies and procedures business processes, or regulations. Requires working knowledge of compliance principles.
Live the DU KE VALUES and adhere to all departmental and organizational policies.
Job allows the opportunity to work independently.
Work requires knowledge of basic grammar and mathematical principles normally required through high school education, with some postsecondary education preferred. Additional training or working knowledge of the related business.
Two years 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
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Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.