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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 Financial Coordinator who will embrace our mission of Advancing Health Together.
The Patient Financial Coordinators (PFCs) are part of a multidisciplinary team charged with the responsibility of providing accurate and professional financial clearance to patients seeking Transplant Services or Chemotherapeutic Services at Duke. The PFCs are responsible for the analysis, validation and regulatory and compliance activities associated with the financial clearance process. The PFCs mitigate the financial risk to Duke by performing an accurate financial clearance review along with a comprehensive analysis of patient and payor specific benefits and patient liability.
Process new referrals for Evaluation / Insurance Verification/Clinical Coordination
Analyze, organize, and utilize complex data and rules related to contracting and patient benefits to provide financial clearance.
Work with DUHS Finance, Managed Care Contracting, Pharmacy assistance programs in the development of agreements for International, self-funded patients and patients with limited benefits.# Interact with Transplant / Oncology Clinical teams (Surgeon, Medical Oncologists, RN Coordinators and Transplant Administration) to obtain treatment plans, discharge planning, concurrent and retrospective review and patient demographics to begin insurance verification process.
Interview admitted patients to obtain required information to begin verification.
Interact with Clinical team s (Surgeon, RN Coordinators and Transplant Administration) prior to a patients financial clearance, providing key information and data regarding benefits, support and patient financial liability.
Prepare financial packets based on each individual patients benefits, patient financial interview, and calculated estimated expenses based on patient benefits.
Financial screen daily / weekly with the clinical teams at each of their respective meetings.
Notify the patient if not financially approved for evaluation at Duke and redirect these patients to the insurance payers case manager
Data Maintenance and billing information for (Transplant specific)
Identify the correct patient in Maestro Care (MC).
Accurately identify which account is to be used for the visit.
Update demographic and insurance information in MC and the transplant database when informed of changes.
PFCs perform a review of each patient visit to determine if a visit was transplant related in order for accurate billing to occur.
Communication with the clinicians occurs daily to confirm some visit requirements.
Changes are communicated to the Clinical Team and Administration as necessary.
On-going financial review /analysis patients eligibility, benefit changes and financial status once a patient is accepted for evaluation and through transplant.
Patients are followed approximately up to one year post transplant by the PFC. The PFCs are cross trained to provide weekend and evening coverage for solid organ transplant referrals in an effort to provide timely financial feedback to the surgeons.
Patient Identification / Pre-registration
Identify the correct patient in MC and other systems (i.e Concert).
Accurately identify which account is to be used for the visit.
Update demographic and insurance information in MC
Obtain a Duke Medical Record number for new patients.
Analyze benefits for appropriate coverage for services; review contracts and obtain clarification from managed care contracting and payor coordination as needed.
Resolve MC system alerts for missing or incorrect registration and insurance elements.
Add / edit insurance per policy and procedure.
Clear work queue edits.
Obtain authorizations and pre-certifications as required (see below)
Work with clinical staff to obtain additional clinical information for benefit review in particular as it relates to clinical trials and off label drug use
Interview Patients / Provide Financial Counseling
Meet with patients and family members at the time of transplant evaluation or prior to chemotherapeutic treatment.
Inform patients of the anticipated costs of transplant/chemotherapeutic services, the anticipated patient liability, and the patient responsibilities (e.g. post transplant medications)
Assist patients with a financial plan when not adequately funded for transplant (e.g.fundraising) or therapy services
Implement appropriate collection actions and assist financially responsible persons in arranging payment
Explain billing to patients according to PRMO credit and collection policies
Evaluate patient requests for financial assistance.
Notify the Transplant Clinical team of financial considerations that prevent or delay listing the patient for transplant.
Inform the Oncology Clinical team of financial considerations
Seek clinical assistance as needed for
Refer patients to the Manufacturer Drug program and Pharmacy Assistance programs as needed for medications
Obtaining Authorization and Prior Approval
Analyze benefit requirements and initiate the request for authorization / prior approval for the transplant evaluation, admission, clinic visits, donor compatibility, work-up and testing, organ procurement, ventricular assist devices and follow-up appointments.
Analyze benefit requirements and initiate authorization, pre-certifications and /or pre-determinations for chemotherapy treatments; work with clinical staff to obtain additional clinical information for benefit review in particular as it relates to clinical trials and off label drug use
Prepare the medical packet (including letter of medical necessity and clinical evaluation) required for obtain prior approval, authorization, or pre-certification.
Document authorizations in MC per policy and procedure.
Review denials for evaluation and/or transplant and initiate the appeal process with the insurance payer working collaboratively with the patient, family, and physician.
Work collaboratively with the oncologists for treatment authorization denials and work proactively with the oncologist, drug manufacturer and payor to obtain coverage and prevent post billing authorization denials.
Greets and provides assistance to visitors and patients.
Explains policies and procedures, and resolves problems.
Gathers necessary documentation to support proper handling of inquiries/com plaints.
Courtesy and professional conduct is maintained at all times.
Provides timely and effective service to internal customers.
Case Management (Transplant)
Regularly monitor and work transplant tickler as it relates to waitlisted transplant patients to ensure authorization s and case management and are kept current and up to date on monthly basis.
Request updates to the effective and termination dates of the transplant approval when expired
Review outpatient appointments for active transplant registered patients and resolve any issues related to coverage and payment
High School Diploma required. Advanced degree preferred.
Three years of healthcare experience with a minimum of one year in insurance verification, authorization, or billing experience required. One year of experience with a transplant or chemotherapy program preferred.
Degrees, Licensures, Certifications
Position may be subject to membership with the Transplant Financial Coordinators Association (for Transplant team) and may be subject to certification with TFCA.
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.