Patient Account Associate - Provider Enrollment Denials - Remote

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.

 

About Duke Health's Patient Revenue Management Organization

 

Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's 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.

 

 

REMOTE POSITION: Monday - Friday (8:00 AM - 4:30pm)

 

MUST RESIDE IN NORTH CAROLINA

 

General Description of the Job Class

Record and generate a variety of information pertaining to the patient revenue process. An accurate, high-performance level position requires a certain degree of knowledge of complex rules and the corresponding ability to apply these rules in the work environment to achieve desired outcomes.

Duties and Responsibilities of this Level:

Workload 85%

Fiscal Responsibility: Record or generate revenue by gathering and processing information that impacts the patient revenue process. Fiscal responsibility is measured on high production levels, and quality of work output, in compliance with established DUHS policy standards. May also be defined in terms of the value of the work portfolio assigned and/or revenue expectations.

The Provider Enrollment (PE) Specialist is responsible for preparing and submitting enrollment applications and supporting documentation to enroll individual physicians, physician groups, and hospitals. The PE Specialist researches and resolves billing issues related to Provide r Enrollment. A variety of systems and external tools are utilized to research and resolve provider enrollment issues.

 

· Work closely with clinical departments on notification of a provider's start date, welcome packets, and provider documentation and ensure the providers are in all systems.

 

· Research and resolve bill holds related to provider enrollment.

 

· Update billing system to define billing and service provider effective and termination dates, create payer-specific bill hold s, NPI and NPI subpart numbers, taxonomy codes, and payer-specific provider numbers. Removal of bill holds after enrollment by the payer.

 

· Monitor and advise physicians and providers on license expirations.

 

· Perform follow-up with insurance payers via phone, email, or website to resolve provider enrollment issues.

 

· Monitor the completion and submission of provider enrollment applications for individual providers, clinics, and hospitals.

 

· Assign reminders and follow-up to ensure provider numbers are established and linked to the appropriate group entity promptly.

 

· Understand specific enrollment requirements for each payer and provider type including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations.

 

· Maintain documentation of enrollment packets or spreadsheets related to enrolling Physicians and the present status of the packet.

 

· Work provider enrollment denial work queues to ensure timely response for resolution and provide input to the Supervisor on denials we can reduce.

 

· Establish close working relationships with provider enrollment packet contacts, contracting department, clinical departments, and payer contacts.

 

· Respond to internal and external inquiries on routine enrollment, as appropriate.

 

· Interface regularly with internal staff in AR, registration, and Payer Relations.

 

· Review and resolve AR associated with enrollment denials and cl aim edits.

 

· Resolve AR associated with denials from payors and re solve per payor requests and guidelines.

 

· Maintain passing scores for internal control quarterly audits.

 

· Maintain work queues at less than one week of inventory without loss to timely filing.

 

· Limit the amount of transfers to other work queues.

 

· Make independent decisions for the accurate outcome of working claim edits, denials, no response follow-up, and correspondence documentation.

 

· Adhere to all PRMO and DUHS revenue cycle policies and regulations.

 

· Respect and maintain confidentiality regarding patient/guarantor financial data and patient medical data consistent with HIPAA standards.

 

· Clearly document write-off requests per policy with t