At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
Patient Revenue Management Organization
Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.
Hybrid (Remote First): Monday - Friday (8:00 AM - 5:00PM)
General Description of the Job Class
The Central Financial Services Reimbursement Specialist is required to successfully case manage the growing population of patients without insurance coverage, with high deductibles and co-insurances, with narrow networks of providers, and not living domestically but seeking healthcare abroad. This role in the department is utilized to:
• Review out-of-network/non-contracted patient appointments and new-to-Duke referrals.
• Coordinate efforts for Clinical Review Board processes and approval/denial of out-of-county Medicaid and self-pay patients (adults and PEDs), High Impact Drugs (42 drugs) greater than $200K per patient per year, and 2A High Dollar Infusions.
• Provide an incoming call center for patients, providers, and DUHS front-end team members supporting the patient financial experience.
• Provide reporting on cohorts, including analysis and process improvements.
• Perform account auditing for clean billing and claim auditing for maximum reimbursement.
• Conduct audits of workflows and staff performance, providing remedial education/training to realize performance improvement.
Additional Duties and Responsibilities of this Level
• Maintain professional relationships with internal and external agencies and professional organizations concerning operations.
• Serve as liaison between the physicians and the PRMO.
• Analyze and provide feedback for department-specific reports.
• Coordinate projects and audits to improve processes related to the revenue cycle, efficiency of charging and billing, and collection efforts.
• Coordinate communication between insurance companies, governmental agencies, providers, and support staff.
• Trend and report on departmental performance indicators and goals. Ensure departmental goals are satisfied.
• Make recommendations to improve financial systems; perform in-house audits of operating units; analyze deficiencies and report to manager/director.
• Develop and provide job-specific training to new and existing employees within the department.
• Perform other related duties incidental to the work described herein.
Required Qualifications at this Level
Education High school diploma or equivalent is required, preferably supplemented by post-secondary courses in Accounting, Finance, Economics, Business Administration, or a related field.
Experience Four years of related experience in healthcare is required. A Bachelor's degree in a related field can substitute for the experience requirement.
Degrees, Licensure, and/or Certification N/A
Knowledge, Skills, and Abilities Data analysis and reporting; Billing/Collections; Insurance Claims; Microsoft Office (Excel, Access, Word, PowerPoint). Good communication skills (verbal and written) are essential.
Duke is an 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 (including pregnancy and pregnancy related conditions), sexual orientation or military 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.
