Duke Homecare & Hospice Duke Homecare & Hospice offers hospice, home health and infusion services as well as serves as the home for the Duke Caregiver Support Program. Our Hospice team works closely with a patient's physician to provide comprehensive, individualized care in the comfort their home or at our inpatient hospice facility located in Durham. Our team of nurses, therapists, social workers, counselors, and chaplains help patients and their families manage advanced medical conditions. Duke Home Health provides services in a patient's home that include skilled nursing, physical therapy, occupational therapy, speech therapy, social service, home health aides, and pain and wound management. Our infusion team comes to a patient's home to administer intravenous medications, including antibiotics and chemotherapy, to children and adults. Our nurses, pharmacists, dietitians, and patient services coordinators work under the direction of a patient's doctor to monitor needs and treatment.

Location:

Duke Homecare and Hospice (Durham, North Carolina)

Work Hours:

8am-4:30pm (but that is flexible). This position will require an onsite presence for training. The postiion will move to a hybrid schedule after completion of training.

General Summary

Serves as communication liaison between the insurance company, third party payers, patients, and billing staff for all case management negotiations and financial arrangements. Performs initial patient financial verification, evaluation, documentation and obtains any information required to insure complete accuracy in creating a claim and collecting from a pay source on a set group of accounts assigned. This position must be able to work independently to process complex patient medical claims by therapy and payer specifications to assure accurate and timely claim submission and follow up from the initial referral through final payment.

Work Performed

• 
  Insures confidentiality of patient information through HIPAA Compliance.
• Verifies insurance coverage for a set group of accounts assigned. Processes insurance verification, documents clearly and concisely and e-mails appropriate individuals the information.
• Creates patient financial chart. Maintains patient files with appropriate documentation, including filing all submitted claims, correspondence, and other documentation as needed.
• Maintains accountability for the prompt processing of claims including billing, preparing for mailing or electronic transmitting and the collection of those claims for a set group of accounts assigned.
• Verifies that patient diagnoses and appropriate completed documents meet the requirements of the insurance payer before filing the claim.
• Obtains and follows up on all documentation needed in order to bill.
• Performs case management negotiations and prior approval requests for all three DHCH programs.
• Identifies/coordinates material to be sent to case managers and notifies clinical staff when case management requires their input.
• Provides ongoing communication with case managers for updates/changes/authorizations and reauthorizations.
• Maintains knowledge of reimbursement principles, guidelines for payment, and pricing parameters.
• Conducts pricing negotiations with insurers and case managers based on DHCH policies and procedures.
• Contacts patients with patient financial responsibility. Sends financial responsibility letter to patients.
• Updates and maintains contract proposal book.
• Enters and updates patient demographics and insurance data into computer.
• Uses Event Tracking System to monitor authorizations and reauthorizations.
• Investigates denials from insurance companies that involve up-front verification issues.
• Maintains updated knowledge of collection procedures and laws.
• Prioritizes accounts to maximize dollars in collections.
• Researches and resolves delinquent accounts to insure timely collections and reduce DSO.
• Notifies supervisor of problem accounts.
• Documents all agreements with patients and third party payers in the appropriate areas within the databases.
• Review accounts to determine and implement appropriate collection or refund action.
• Responds to requests for additional documentation, information or clarification from patients and third parties and verifies charges, as requested.
• Submits appropriate documentation for adjustments, write-offs or bad debt to the Supervisor of Billing & Reimbursement.
• Assures final resolution of chart before sending to storage.
• Coordinates with supervisor any IS issues.
• Performs special projects as assigned
• Maintains confidentiality of employee and patient information.
• Exhibits an attitude that promotes harmony and goodwill in the workplace.
• Participates in Performance Improvement Program.
• Promotes quality, comprehensive services through a team approach.
• Perform other related duties incidental to the work described herein.

Knowledge, Skills and Abilities

• 
  Strong understanding of reimbursement guidelines
• Case management
• Medical terminology, coding, third party benefits and collection techniques.
• Work requires at least two years’ experience in billing & reimbursement with an understanding of case management in home infusion, home health, and/or a hospice setting.
• Must be computer literate.

Minimum Qualifications

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 access, physician office or billing and collections or an equivalent combination of relevant education and/or experience.

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.

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 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.