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 Duke’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.

Occ Summary

Accurately complete patient accounts based on de partmental protocol,policies and procedures, and compliance with regulat ory agencies, toinclude but not limited to pre-admission, admission, pre -registrationand registration functions. Ensure all insurance requiremen ts are metprior to patients' arrival and inform patients of their financ ialliability prior to arrival for services. Arrange payment options with the patients and screens patients for government funding sources.

Work Performed

Analyze insurance coverage and benefits for service to ensure timelyreimbursement. Obtain all Prior Authorization C ertification and/orauthorizations as appropriate. Facilitate payment sou rces for uninsuredpatients. Determine if patient's condition is the resu lt of an accidentand perform complete research to determine the appropri ate source ofliability/payment. Admit, register and pre-register patient s withaccurate patient demographic and financial data. Resolve insurance claim rejections/denials and remedy expediently.Calculate andcollect cas h payments appropriately for all patients. Reconcile dailycash deposit. Evaluate diagnoses to ensure compliance with the LocalMedicare Review Po licy. Perform those duties necessary to ensure allaccounts are processed accurately and efficiently. Compile departmentalstatistics for budgetar y and reporting purposes.Explain billsaccording to PRMO credit and colle ction policies. Implement appropriatecollection actions and assist finan cially responsible persons inarranging payment. Make referral for financ ial counseling. Determinenecessity of third party sponsorship and proces s patients in accordancewith policy and procedure. Examine insurance pol icies and other thirdparty sponsorship materials for sources of payment. Inform attendingphysician of patient financial hardship. Complete the m anaged carewaiver form for patients considered out of network and receiv ingservices at a reduced benefit level. Update the billing system torefl ect the insurance status of the patient. Refer patients to theManufactur er Drug program as needed for medications. Greet andprovides assistance to visitors and patients. Explain policies andprocedures, and resolves p roblems. Gathers necessary documentation tosupport proper handling of in quiries and complaints. Assist withdepartmental coverage as requested.Ob tain authorizations basedon insurance plan contracts and guidelines. Doc ument billing systemaccording to policy and procedure. Enter and updatereferrals asrequired. Communicate with insurance carriers regarding clin icalinformation requested and to resolve issues relating to coverage and payment.

Knowledge, Skills and Abilities

Excellent c ommunication skills, oral and written. Ability to analyzedata, perform m ultiple tasks and work independently. Must be able todevelop and maintai n professional, service-oriented workingrelationships with patients, phy sicians, co-workers and supervisors.Must be able to understand and compl y with policies and procedures.

Level Characteristics

Position responsible for high production generated accurately inaccorda nce with established business processes or regulation. Requiresworking k nowledge of compliance principles.Job allows the opportunityto work ind ependently.

Minimum Qualifications

Education

Work requires knowledge of basic grammar and mathematical principles normally required through a high school education, withsome postsecondary education preferred. Additional training or working knowledge of related business.

Experience

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

None required

 

Duke is an Affirmative Action/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, sexual orientation, or veteran status.

 

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

 

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.

 

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