Reimbursement Specialist - Central Financial Services - 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

*** MUST RESIDE IN NORTH CAROLINA***

The Central Financial Services Reimbursement Specialist is requ ired to successfully case manage the growing population of patients with out insurance coverage, with high deductibles and co-insurances, with na rrow networks of providers, and not living domestically but seeking heal thcare abroad. This role in the department is utilized to:

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• Review of out-of-network/non-contracted patient appointm ents & new to Duke Referrals.
• Coordinate effor ts for Clinical Review Board processes approval/denial of: Out of county Medicaid & Self-Pay patients (adults and PEDs), High Impact Drugs ( 42 drugs) > $200K per patient per year, and 2A High Dollar Infusions.
• Incoming call center for patients, providers, and DUH S front-end team members to the patient financial experience.
• Provide reporting on cohorts to include analysis and process improvements;
• Perform account auditing for clean b illing and claim auditing for maximum reimbursement;
• Conduct audits of workflows and staff performance; providing remedial education/training to realize performance improvement.

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Additional Duties and Responsibilities of this Level: 

• Maintain professional relationship with internal and external agencies and professional organizations concerning operations.  
• Serve as liaison between the physicians and t he PRMO.  
• Analyze and provide feedback for departm ental specific reports.  
• Coordinates projects and audits to improve processes related to revenue cycle, efficiency of char ging and billing, and collection efforts.  
• Coordin ate communication between insurance companies, governmental agencies, pr oviders and support staff.  
• Trend and report on departmental performance indicators and goals. Ensure departmental goals a re satisfied.  
• Make recommendations to improve fin ancial systems; perform in house audits of operating units; analyze defi ciencies and report to manager/director.  
• Develop and provide job-specific training to new and existing employees within d epartment.  
• Perform other related duties incidenta l to the work described herein.  

Knowledge, Skills , and Abilities:

Dat a analysis and reporting Billing/Collections Insurance Claims Microsof t Office (Excel, Access, Word, PowerPoint) Good communication skills ( verbal and written) are essential.

Minimum Qualifications

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, Licensures, Certifications

N/A

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.

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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.