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Patient Account Team Lead - Authorization Denial Team - Remote
Duke University Health System
Location: Durham, North Carolina
Internal Number: 190748
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 Dukeâ€™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.
Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Patient Account Team Lead who will embrace our mission of Advancing Health Together.
General Description of the Job Class
Resolve high dollar account balances related to authorization denials for Duke University Health System hospital and professional claims.Research issues pertaining to delayed payments and identify areas of process improvements needed to expedite A/R resolution.
Duties and Responsibilities of this Level:
Authorization Denial Follow-up
·Perform follow-up of high dollar account balances outstanding with insurance payors due to authorization denials and take necessary correct action for resolution
·Research and resolve denied claims by correcting the account issue and/or appealing to the payer based on payer and billing guidelines.
·Take ownership of resolution to assigned high dollar accounts in a timely and accurate manner.
·Establish professional relationships with payers and other operational areas with in DUHS and PDC to work together in resolution of A/R.
·Maximize reimbursement in compliance with payor regulations and PRMO policy and procedure
· Consistently achieve and maintain performance standards for assigned productivity, collections, and quality targets
·Works and maintains consistent follow up on High Dollar accounts in the assigned High Dollar WorkQues and documents actions taken and sets appropriate follow up Account Activity Codes.
DUHS Team Support
· Identify trends and opportunities for improvement for operational, payer, system and/or user issues.
·Escalate trends to management with resolution ideas/opportunities.
·Proactively monitor payer rules and guidelines related to billing and collections changes/and or updates.
·As requested by management, provide support to other employees within team or on another team to address inventory backlogs or staffing shortages
Other Tasks as Assigned
·Other duties as assigned
College degree preferred or significant years of patient revenue cycle/process experience in lieu of college degree. Additional specialized training relevant to job responsibility.
5 years experience in a Healthcare or Business setting or an equivalent combination of relevant education and/or experience engaged in analytical and compliance issues.
Degrees, Licensures, Certifications
Certification in related field of experience preferred but not 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.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.