Customer Service Associate, Financial Services
- Accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, to include but not limited to pre-admission, admission, pre-registration, registration and customer service functions.
- Ensure all insurance requirements are me me met prior to patients' 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.
- The Central Financial Service (CFS) Team is responsible for the pre-service financial clearance of international patients, patients with non-contracted plans, and new self-pay and Medicaid patients for the PDC and all hospitals within Duke University Health System.
- CFS is also responsible for working claim edits, analyzing and answering billing questions, facilitating review board calls and tr training our CFS processes to other areas at Duke.
- International Patient Work with the International Patient Services office to financially clear international patients prior to scheduling appointments.
- Monitor the patient work queue to ensure all patients registered as international patients are contacted prior to service.
- Request verification of benefits from the international patient office and send letters of agreements to the international self-pay patients.
- Non-Contracted Receive and respond to incoming phone calls from scheduling, and other areas at Duke that schedule, with non-contract insurance holders on the phone.
- Provide insurance benefit education to patients with non-contracted plans.
- Analyze insurance coverage and benefits for service to ensure timely reimbursement.
- Calculate and collect cash payments appropriately for patients with non-contracted plans deciding to come to a Duke facility.
- Out-of-County Self-Pay/Medicaid Review incoming referrals for new patients seeking appointments with out of county Medicaid or self-pay coverage and residing in a county outside of Durham or Wake.
- Facilitate financial cl clearance via communication with referring offices, scheduling teams and Duke Providers as appropriate.
- Respond to physicians inquires and requests.
- Facilitate and/or attend weekly clinical re review board meetings to document decisions and communicate with referring providers and re referring offices as appropriate.
- Infusion Clinic and High Impact Drug review boards
- Review and work new referrals for clinic.
- Infusion center and high impact drugs for the weekly review boards.
- Facilitate and/or attend weekly clinical review board meetings to document decisions and communicate with clinical areas as appropriate.
- Work closely with clinic and Pre-Service Verification teams to ensure proper pre Service
- Verification teams to ensure proper pre Service Verification teams to ensure proper pre Service Verification teams to ensure proper pre-authorization, clinical notes and required detail is obtained.
- Gather necessary documentation to support proper handling of inquiries and complaints.
- Explain bills according to PRMO credit and collection policies. Examine insurance policies and other third party sponsorship materials for sources of payment.
- Reconcile daily cash deposit when cash is collected.
Knowledge, Skills and Abilities
- Excellent communication skills, oral and written.
- Attentive to the needs of internal and external customers.
- 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.
- Experience, Education and Licensure
- A minimum of two years of customer service experience is required.
- A healthcare background working in medical billing, collections, insurance claims processing, coding, registration or working in a physician’s office is required.
- Inbound to outbound call center experience preferred.
- Working knowledge of the Epic systems preferred.
- Equivalent combination of relevant education and experience considered.
- No licensure required.
Duke Entity PRMO
Job Family Level C2
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. Two-year college degree preferred.
A minimum of three years direct customer service or call center operations experience is required. A healthcare background working in medical billing, collections, insurance claims processing, coding, registration, working in a medical organization, or like experience in the fields of education, training, training development, is highly preferred. Inbound to outbound call center experience preferred. Working knowledge of Maestro Care system preferred.
Degrees, Licensures, Certifications