SPECIAL PROGRAMS - VENDORS
General Description of the Job Class:
Perform the activities of the Quality Review & Training Support Team in Professional and Hospital Collections.
Duties and Responsibilities of this Level:
Quality Reviews and Auditing:
- Perform Quality Audit reviews on each employee according to PRMO Collections: Quality Review Policy and Procedure.
- Maintain documentation files to record all Quality Audit scores/trends, maintaining compliance guidelines.
- Trend and report questionable rejections.
- Meet with Management staff regularly to share Quality Audit findings/results.
- Offer recommendations to change/update scorecards as appropriate.
- Develop and maintain Training Modules for all Teams, Functions, and Policies.
- Prepare and maintain Excel Training Report of all training activities completed per employee.
- Coordinate training process with Manager and Supervisor of new hire and plan appropriate training schedule during trial period or probationary period as requested by management.
- Provide documentation of learning materials and feedback
- Work with associates in needed areas based on new hire check-off lists and re-verification training check-off lists as requested my management.
- Provide documentation of learning materials and feedback
- Develop and distribute Policy and Procedures.
- Provide policy revisions and refresher training with distribution to staff in a timely manner.
- Recommend training modules based on reverification records from the Insurance Team management.
- Maintain the learning pod documentation keeping it current.
- Attend Section Meetings, as needed, to present training materials or new information to staff.
- Attend question times on a weekly basis with management as needed.
- Recommend training modules based on Quality Audit review trends.
- Investigate and respond with instructions in a timely manner.
- Interacts with and provides verbal and written responses to providers, patients, third party payers and departmental personnel.
- Participates in the development of operating goals and objectives for the unit; recommends, implements, and administers operating protocol and procedures to enhance operations.
- Attends meetings and participates on committees, as assigned.
Additional Duties and Responsibilities
Accomplishes all tasks as appropriate. Serves as backup to Claim Edit Analyst as needed.
Work prefers a minimum of 5 years of healthcare experience, with a focus on hospital/professional billing and collections.
Knowledge, Skills, and abilities:
- Excellent communication skills, oral and written
- Ability to systematically analyze problems, draw relevant conclusions and devise appropriate course of action
- Ability to analyze data, perform multiple tasks and work independently
- Must be able to develop and maintain professional, service-oriented working relationships with senior leadership, patients, physicians, co-workers and employees.
- Ability to work in a fast paced environment, with focus on team building
- Experience with patient account billing systems
- Microsoft Word
- Microsoft Excel
- Maestro Care
- Microsoft Powerpoint
- Microsoft Access
- Med Assets
- Hyland (Imaging Solution)
Distinguishing Characteristics of this Level:
The successful candidate will possess a wide range of personality traits, work habits, communication and social skills necessary to perform and work effectively within the corporate environment. This person will have both personal and professional integrity, strong communication skills and a professional appearance and presentation. In addition, the qualified candidate will have a strong desire to succeed in a challenging environment.
Other competencies and best practices for high performers include:
- Integrity and compliance: Can be relied upon to act ethically, to safeguard confidential information and to adhere to the Hospital’s Mission and Code of Conduct and all legal and regulatory requirements
- Decision-making: Makes quality decisions in a timely manner; perform independent critical decision making that best serves the interest of the organization as well as our patients
- Coaching and developing others: Guides others in performing effectively and provides others with development opportunities; provides direction without moving responsibility and allows others to determine the best approach to executing assignments. Share knowledge and experience with less experienced staff to assist management in team development
- Team Building: Demonstrate solid skills in working with a large diverse workforce in a a complex operating environment
4566 REIMBURSEMENT SPECIALIST
Job Family Level
Full Time / Part Time
Regular / Temporary
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.
High school diploma or equivalent is required, preferably supplemented by post-secondary courses in Accounting, Finance, Economics, Business Administration or a related field.
Four years of related experience in healthcare is required. A Bachelor's degree in a related field can substitute for the experience requirement.
Degrees, Licensures, Certifications:
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