Financial Care Counselor - DRH Outpatient
Independent Educational Consultants Association, Durham, NC, United States
At Duke Health, we are committed to compassionate care that advances health together.
Financial Care Counselor
Work hours: Monday - Friday 9:30am - 6:00pm
Commitment Bonus Program: $5,000.00, paid in 2 installments over 12 months (6 month increments).
Responsibilities
Accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, including pre‑admission, admission, pre‑registration and registration functions.
Ensure all insurance requirements are met prior to patient arrival and inform patients of their financial liability prior to arrival for services.
Arrange payment options with patients and screen patients for government funding sources.
Analyze insurance coverage and benefits for services to ensure timely reimbursement.
Obtain authorizations based on payment on insurance plan contracts and guidelines.
Document billing system.
Explain bills and provide assistance to visitors and patients.
Explain policies and departmental coverage as requested.
Calculate and process according to PRMO credit and collection policies.
Implement appropriate cash payments for all patients.
Reconcile daily third‑party sponsorship and process patients in accordance with reimbursement.
Obtain all prior authorization certifications 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.
Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy.
Perform duties necessary to ensure all accounts are processed accurately and efficiently.
Compile departmental statistics for budgetary and reporting purposes.
Assist financially responsible persons in arranging payment and collection actions.
Make referral for financial counseling.
Determine policies and procedures as required.
Examine insurance policies and third‑party sponsorship materials for sources of payment.
Inform attending physician of patient financial hardship.
Complete managed care waiver forms 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 patients and resolve problems.
Gather necessary documentation to support proper handling of inquiries and complaints.
Assist according to policy and procedure.
Enter and update referrals as required.
Communicate with insurance carriers regarding clinical information requested and resolve issues relating to coverage.
Knowledge, Skills & Abilities
Excellent oral and written communication skills.
Ability to analyze relationships with patients, physicians, co‑workers and supervisors; manage multiple tasks and work independently.
Develop and maintain professional, service‑oriented working relationships.
Understand and comply with policies and procedures.
Level Characteristics
Position responsible for high production generated accurately in accordance with established business processes or regulation.
Requires working knowledge of compliance principles. The job allows the opportunity to work independently.
Minimum Qualifications
Education
Knowledge of basic grammar and mathematical principles normally required through a high school education; some post‑secondary education preferred.
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.
Certificates
No specific degree, licensure or certification required.
Equal Opportunity Employer
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.
Essential Physical Job Functions
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.
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Financial Care Counselor
Work hours: Monday - Friday 9:30am - 6:00pm
Commitment Bonus Program: $5,000.00, paid in 2 installments over 12 months (6 month increments).
Responsibilities
Accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, including pre‑admission, admission, pre‑registration and registration functions.
Ensure all insurance requirements are met prior to patient arrival and inform patients of their financial liability prior to arrival for services.
Arrange payment options with patients and screen patients for government funding sources.
Analyze insurance coverage and benefits for services to ensure timely reimbursement.
Obtain authorizations based on payment on insurance plan contracts and guidelines.
Document billing system.
Explain bills and provide assistance to visitors and patients.
Explain policies and departmental coverage as requested.
Calculate and process according to PRMO credit and collection policies.
Implement appropriate cash payments for all patients.
Reconcile daily third‑party sponsorship and process patients in accordance with reimbursement.
Obtain all prior authorization certifications 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.
Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy.
Perform duties necessary to ensure all accounts are processed accurately and efficiently.
Compile departmental statistics for budgetary and reporting purposes.
Assist financially responsible persons in arranging payment and collection actions.
Make referral for financial counseling.
Determine policies and procedures as required.
Examine insurance policies and third‑party sponsorship materials for sources of payment.
Inform attending physician of patient financial hardship.
Complete managed care waiver forms 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 patients and resolve problems.
Gather necessary documentation to support proper handling of inquiries and complaints.
Assist according to policy and procedure.
Enter and update referrals as required.
Communicate with insurance carriers regarding clinical information requested and resolve issues relating to coverage.
Knowledge, Skills & Abilities
Excellent oral and written communication skills.
Ability to analyze relationships with patients, physicians, co‑workers and supervisors; manage multiple tasks and work independently.
Develop and maintain professional, service‑oriented working relationships.
Understand and comply with policies and procedures.
Level Characteristics
Position responsible for high production generated accurately in accordance with established business processes or regulation.
Requires working knowledge of compliance principles. The job allows the opportunity to work independently.
Minimum Qualifications
Education
Knowledge of basic grammar and mathematical principles normally required through a high school education; some post‑secondary education preferred.
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.
Certificates
No specific degree, licensure or certification required.
Equal Opportunity Employer
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.
Essential Physical Job Functions
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.
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