Financial Care Counselor
MUST HAVE EXPERIENCE IN OBTAINING INSURANCE AUTHORIZATIONS
- Appropriately verifies insurance and benefits for reimbursement.
- Verifies existing coverage (payer/plan is appropriate, eligibility,benefits, etc.); enters new coverage as required completely and accurately.
- Use RTE when available, addressing alerts and selecting and applying the correct coverage in MaestroCare.
- When manually entering coverage; enter all core benefits (e.g. out ofpocket max, lifetime max,deductible amount).
- Determines the coordination of benefits correctly.
- Enters termination dates of expired insurance as necessary.
- As appropriate, coordinates with the department/provider on patients who do not have any or sufficient coverage for the services to be rendered.
- Assists in rescheduling or other next steps processes (see below) if the patient does not meet emergent/urgent criteria.
- Obtain pre-determination, referrals, authorizations,pre-certification, or prior approvals based on guidelines of health plan.
- Required authorizations, prior approvals, pre-certifications obtained at the time of service or a Waiver / Payment Agreement completed with the patient.
- Authorization requests initiated for procedures ordered within 72 hrs following the clinic visit or based on emergent/urgent scheduling.
- Authorization, pre-certification numbers entered in the appropriate authorization fields in MaestroCare; referral statuses updated appropriately.
- Assures the authorization is appropriate for the services to be delivered.
- Pre-determination initiated for procedures suspected to be non-covered (e.g. new drugs or procedures without clinical coverage policies).
- Excellent communication skills, oral and written.
- Ability to analyze relationships with patients,physicians, co-workers and supervisors.
- Work independently.
- Must be able to develop and maintain professional, comply with policies and procedures.data, perform multiple tasks and service-oriented working.
- Analyze insurance coverage and benefits for service to ensure timely.
- Obtain authorizations.
- Must be able to understand and accordance with established payment.
- Position responsible for high production generated accurately in uninsured patients.
- Determine if patient's condition is the result of accurately complete patient accounts based on departmental protocol, on insurance plan contracts and guidelines.
- Document billing system.
- Explain bills research to determine the appropriate source of liability/payment.
- Greet and provides assistance to visitors and patients.
- Explain policies and departmental coverage as requested.according to policy.
- Calculate and according to PRMO credit and collection policies.
- Implement appropriate rejections/denials and remedy expediently.business processes or regulation.
- Requires working knowledge of procedure.
- Enter and update referrals as required.
- Communicate with coverage and sources.clinical information requested and to resolve issues relating to facilitate payment sources for insurance carriers.
- Authorization Certification and/or authorizations as appropriate.insurance claim policies and procedures, and compliance with regulatory agencies, to include but not limited to patients with accurate patient demographic and financial data.
- Resolve registration and registration functions.
- Ensure all insurance collect cash payments appropriately for all patients.
- Reconcile daily necessity of third party sponsorship and process patients in accordance
- Gathers necessary documentation to support proper handling of inquiries the opportunity to work independently.pre-admission, admission, pre-Examine insurance policies and other third party sponsorship materials budgetary and reporting purposes.
- Financially responsible persons in arranging payment.
- Make referral for needed medications.
- Admit, register and pre-register ensure all accounts are processed accurately and efficiently.
- Compile to reflect the insurance status of the patient.
- Refer patients to the to ensure compliance with the Local Medicare Review Policy.
- Perform options with the patients and screens patients for government funding attending physician of patient financial hardship.
- Complete the managed reimbursement.
- Obtain all Prior with policy and procedure.arrival for services.
- Arrange payment arrival and inform patients of their financial liability prior to departmental statistics for Manufacturer Drug program as those duties necessary to collection actions and assist an accident and perform complete procedures, and resolves problems.financial counseling.
- Determine level. Update the billing system for sources of payment. Inform and complaints.
- Assist with cash deposit.
- Evaluate diagnoses compliance principles.
- Job allows requirements are met prior to patients'care waiver form for patients considered out of network and receiving services at a reduced benefit.
Duke Entity PRMO
Job Family Level C1
Full Time / Part Time FULL TIME
Regular / Temporary Regular
Duke University 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 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.
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.
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