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FINANCIAL CARE COUNSELOR
Job Title: FINANCIAL CARE COUNSELOR
Job Code: 4500
FLSA: N
Job Level: C1
Revised Date: 06/27/2005
Supervisory Responsibility: No
General Description of the Job Class
Accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, to include but not limited to pre-admission, admission, pre-registration and registration functions. Ensure all insurance requirements are met prior to patients' arrival and inform patients of their financial liability prior to arrival for services. Arrange payment options with the patients and screens patients for government funding sources.
Duties and Responsibilities of this Level
Analyze insurance coverage and benefits for service to ensure timely reimbursement. Obtain all Prior Authorization Certification and/or authorizations as appropriate. Facilitate payment sources for uninsured patients. Determine if patient's condition is the result of an accident and perform complete research to determine the appropriate source of liability/payment. Admit, register and pre-register patients with accurate patient demographic and financial data. Resolve insurance claim rejections/denials and remedy expediently.
Calculate and collect cash payments appropriately for all patients. Reconcile daily cash deposit. Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy. Perform those duties necessary to ensure all accounts are processed accurately and efficiently. Compile departmental statistics for budgetary and reporting purposes. Explain bills according to PRMO credit and collection policies. Implement appropriate collection actions and assist financially responsible persons in arranging payment. Make referral for financial counseling. Determine necessity of third party sponsorship and process patients in accordance with policy and procedure. Examine insurance policies and other third party sponsorship materials for sources of payment. Inform attending physician of patient financial hardship. Complete the managed care waiver form for patients considered out of network and receiving services at a reduced benefit level. Update the billing system to reflect the insurance status of the patient. Refer patients to the Manufacturer Drug program as needed for medications. Greet and provides assistance to visitors and patients. Explain policies and procedures, and resolves problems. Gathers necessary documentation to support proper handling of inquiries and complaints. Assist with departmental coverage as requested.
Obtain authorizations based on insurance plan contracts and guidelines. Document billing system according to policy and procedure. Enter and update referrals as required. Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment.
Required Qualifications at this Level
Education
Work requires knowledge of basic grammar and mathematical principles normally required through a high school education, with some postsecondary education preferred. Additional training or working knowledge of related business.
Experience
Two years experience working in hospital service access, clinical service access, physician office or billing and collections. Or, an Associate's degree in a healthcare related field and one year of experience working with the public. Or, a Bachelor's degree and one year of experience working with the public.
Degrees, Licensure, and/or Certification
None required
Knowledge, Skills, and Abilities
Excellent communication skills, oral and written. Ability to analyze data, perform multiple tasks and work independently. Must be able to develop and maintain professional, service-oriented working relationships with patients, physicians, co-workers and supervisors. Must be able to understand and comply with policies and procedures.
Distinguishing Characteristics of this Level
Position responsible for high production generated accurately in accordance with established business processes or regulation. Requires working knowledge of compliance principles. Job allows the opportunity to work independently.
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Duke University 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 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.
