Patient Account Associate - Special Programs: Vendors - 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: 8:00a - 4:30pm)

 

MUST RESIDE IN NORTH CAROLINA

 

General Description of the Job Class:

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

 

Duties and Responsibilities of this Level:

Workload 85%

• Review and resolve AR associated with all payors.

 

• Works closely with vendors, Payor Relations and other operational areas for resolution of outstanding AR.

 

• Updates registration for patients when working registration related denials.

 

• Review payor websites for claim status information on outstanding AR or pending appeals/med doc submissions.

 

• Resolve AR associated with denials from payors and resolve per payor requests and guidelines.

 

• Review and resolve AR related to vendor question work queues and provide appropriate responses for resolution.

 

• Provide support to all books of business within the department that include claim edits, claim denials, insurance follow up and claim stat using.

 

• Achieve 100% of project ed cash collections for DHIP and DPC.

 

• Maintain a DRO of 35-40 days for DHI P and 25-30 for DPC.

 

• < /span>Reduce DHIP Insurance A/R >150 days to less than 10%.

 

• Reduce overall DHIP denial rate for billing to <3% and registration to <1.25%.

 

• Maintain passing score for internal control quarterly audits.

 

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

 

• Limited amount of transfers to other work queues.

 

• Makes independent decisions for 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 request s per policy with appropriate paycode. 

 

• Adheres to DUHS badge swiping and time and attendance policies.

 

• Turns in weekly Productivity Time Tracking Sheet in an accurate and timely fashion.

 

• Maintain non-productive time at less than 4% for the reporting period.

 

• Make process improvement suggestions to Management for daily tasks, in an effort to reduce inventory at a faster rate.

 

• Demonstrates the ability to use time management and organizational skills to keep A/R thresholds at an exceeds level.

 

• Proactively reports trends and system related problems to Management as soon as it is first noticed.

 

Workload 5%

Customer Service: Initiate and develop relationships with customers in order to gather and process information or resolve issues in order to receive accurate reimbursement and optimize internal and external customer satisfaction.

 

• Consistently responds to issues within two business days.

 

• Consistently respond to Supervisor/Team/Customer inquiries, providing appropriate feedback; alleviating the need for unnecessary follow up.

 

• Consistently demonstrates the ability to accept change within the team and department.

 

• Maintains minimal use of company phones, internet and e-m ail for personal usage within our policies and procedures.

 

• In caring for our patients, loved ones and each ot