Duke University Health System
Patient Service Representative - Outpatient Medication Authorization
Duke University Health System, Durham, North Carolina, United States, 27703
Patient Service Representative – Outpatient Medication Authorization
Duke University Health System
Overview At Duke Health, we are committed to compassionate care that changes patients’ lives and the community. This role is part of the Patient Revenue Management Organization, our centralized revenue cycle unit that supports scheduling, registration, coding, billing and related functions across the entire system.
About Duke Health’s Patient Revenue Management Organization The PRMO is the full‑service revenue cycle organization that streamlines processes across the health system. It manages patient accounts, insurance verification, authorizations, and collections.
Job Summary The Patient Service Representative is responsible for accurate and complete patient accounts based on departmental protocols and regulatory requirements. Responsibilities include pre‑admission, admission, pre‑registration, and registration functions, ensuring all insurance requirements are met before the patient’s arrival, informing patients of their financial liability, arranging payment options, and screening for government funding sources. The role requires high‑level customer service interactions with payors and physicians by phone and is similar to a Financial Care Counselor, completing preliminary work before the patient arrives.
Key Responsibilities – Work Performed • Analyze insurance coverage and benefits to ensure timely reimbursement.
• Obtain PAC and/or authorizations as appropriate and facilitate referrals to Financial Services for uninsured patients.
• Determine liability for accidental conditions and research appropriate payment sources.
• Schedule and pre‑register patients, correcting demographic and financial data.
• Resolve insurance claim rejections/denials promptly.
• Call patients about balances, copays, deductible, and co‑insurance.
• Evaluate diagnoses for Medicare Review Policy compliance.
• Educate patients about billing per PRMO policy, discuss insurance, and implement collection actions.
• Refer patients to Financial Services for counseling and determine third‑party sponsorship when necessary.
• Update billing system to reflect insurance status.
• Provide effective customer service to internal customers and assist with departmental coverage as requested.
• Obtain authorizations according to insurance plans and document in the billing system.
• Communicate with carriers to resolve coverage and payment issues.
Knowledge, Skills & Abilities • Excellent oral and written communication skills.
• Ability to analyze data, manage multiple tasks and work independently.
• Ability to develop professional, service‑oriented relationships with patients, physicians, coworkers and supervisors.
• Ability to understand and comply with policies and procedures.
Eligibility & Minimum Qualifications Education
High‑school diploma required; some post‑secondary education or related business training preferred.
Experience
Two to five years in hospital access, physician office or billing and collections, or equivalent education and experience.
Certifications / Licensure
None required.
Seniority Level
Entry level
Employment Type
Full‑time
Job Function
Health Care Provider
Industries
Hospitals and Health Care
Equal Opportunity Statement Duke is an equal‑opportunity employer committed to providing employment opportunities regardless of 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.
Essential Physical Job Functions Some functions may require specific physical or mental abilities. Additional information and accommodation requests are provided by the hiring department.
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Overview At Duke Health, we are committed to compassionate care that changes patients’ lives and the community. This role is part of the Patient Revenue Management Organization, our centralized revenue cycle unit that supports scheduling, registration, coding, billing and related functions across the entire system.
About Duke Health’s Patient Revenue Management Organization The PRMO is the full‑service revenue cycle organization that streamlines processes across the health system. It manages patient accounts, insurance verification, authorizations, and collections.
Job Summary The Patient Service Representative is responsible for accurate and complete patient accounts based on departmental protocols and regulatory requirements. Responsibilities include pre‑admission, admission, pre‑registration, and registration functions, ensuring all insurance requirements are met before the patient’s arrival, informing patients of their financial liability, arranging payment options, and screening for government funding sources. The role requires high‑level customer service interactions with payors and physicians by phone and is similar to a Financial Care Counselor, completing preliminary work before the patient arrives.
Key Responsibilities – Work Performed • Analyze insurance coverage and benefits to ensure timely reimbursement.
• Obtain PAC and/or authorizations as appropriate and facilitate referrals to Financial Services for uninsured patients.
• Determine liability for accidental conditions and research appropriate payment sources.
• Schedule and pre‑register patients, correcting demographic and financial data.
• Resolve insurance claim rejections/denials promptly.
• Call patients about balances, copays, deductible, and co‑insurance.
• Evaluate diagnoses for Medicare Review Policy compliance.
• Educate patients about billing per PRMO policy, discuss insurance, and implement collection actions.
• Refer patients to Financial Services for counseling and determine third‑party sponsorship when necessary.
• Update billing system to reflect insurance status.
• Provide effective customer service to internal customers and assist with departmental coverage as requested.
• Obtain authorizations according to insurance plans and document in the billing system.
• Communicate with carriers to resolve coverage and payment issues.
Knowledge, Skills & Abilities • Excellent oral and written communication skills.
• Ability to analyze data, manage multiple tasks and work independently.
• Ability to develop professional, service‑oriented relationships with patients, physicians, coworkers and supervisors.
• Ability to understand and comply with policies and procedures.
Eligibility & Minimum Qualifications Education
High‑school diploma required; some post‑secondary education or related business training preferred.
Experience
Two to five years in hospital access, physician office or billing and collections, or equivalent education and experience.
Certifications / Licensure
None required.
Seniority Level
Entry level
Employment Type
Full‑time
Job Function
Health Care Provider
Industries
Hospitals and Health Care
Equal Opportunity Statement Duke is an equal‑opportunity employer committed to providing employment opportunities regardless of 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.
Essential Physical Job Functions Some functions may require specific physical or mental abilities. Additional information and accommodation requests are provided by the hiring department.
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