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Posted: 01-May-26
Location: Durham, North Carolina
Internal Number: 269337
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 South Clinic 1 F
Work Hours: 730am-4pm (Monday-Friday)
Occ Summary
Accurately complete patient accounts based on departmental protocol, policies, and procedures and compliance with regulatory agencies, to include but not be 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 screen patients for government funding sources.
Work Performed
Analyze insurance coverage and benefits for service to ensure timely reimbursement. Obtain all prior authorization certifications 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 andfinancial 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 a referral for financial counseling. Determine the 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 the 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. Greets and provides assistance to visitors and patients. Explains 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 the 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.
Knowledge, Skills and Abilities
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.
Level Characteristics
Position responsible for high production generated accurately in accordance with established business processes or regulations. Requires working knowledge of compliance principles. Job allows the opportunity to work independently.
Minimum Qualifications
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 years of 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
None required
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.
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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 provision for requests for reasonable accommodation will be provided by each hiring department.