Financial Care Counselor - Outpatient Rehab; Apex

Overview

At Duke Health, we are 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.

Duke Raleigh Knightdale

Financial Care Counselor

7:00 am – 6:00 pm Mon‑Fri;
Main Shift: 7:00 am – 3:30 pm

DUHS Commitment Bonus Program: $5,000.00 paid in 2 installments over 12 months (6‑month increments). Only new hires who have not worked for Duke University in the past 12 months (at the time of offer) are eligible.

• Accurately complete patient accounts based on departmental protocols, policies and procedures, including 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 before services.
• Arrange payment options with patients and screen patients for government funding sources.
• Analyze insurance coverage and benefits for services to ensure timely authorization based on insurance plan contracts and guidelines.
• Document billing system operations and explain bills to provide assistance to visitors and patients.
• Explain policies and departmental coverage as requested.
• Calculate and apply PRMO credit and collection policies.
• Implement appropriate cash payment collection for all patients.
• Reconcile daily third‑party sponsorship necessity and process patients in accordance with reimbursement policies.
• Obtain prior authorization certificates and/or authorizations as appropriate.
• Facilitate payment sources for uninsured patients.
• Determine if a patient’s condition is the result of an accident and research appropriate liability/payment sources.
• Admit, register and pre‑register patients with accurate demographic and financial data.
• Resolve insurance claim rejections/denials and remedy expediently.
• Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy.
• Perform all duties necessary to ensure accounts are processed accurately and efficiently.
• Compile departmental statistics for budgetary and reporting purposes.
• Assist financially responsible persons in arranging payment and collection actions.
• Refer patients to financial counseling and other resources.
• Determine appropriate actions per policy and procedure.
• Examine insurance policies and third‑party sponsorship materials for payment sources.
• Inform attending physicians 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 insurance status of patients.
• Refer patients to the Manufacturer Drug program as needed for medications.
• Greet patients and resolve problems, gathering necessary documentation to support inquiries and complaints.
• Assist with tasks according to policy and procedure.
• Enter and update referrals as required.
• Communicate with insurance carriers regarding clinical information requested and resolve coverage issues.

• Excellent oral and written communication skills.
• Ability to analyze relationships with patients, physicians, co‑workers, and supervisors; perform multiple tasks and work independently.
• Ability to develop and maintain professional, service‑oriented working relationships.
• Ability to understand and comply with policies and procedures.

• 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.

Education
:
Basic grammar and mathematical principles normally required through a high school education; additional post‑secondary education preferred; additional training or working knowledge of related business acceptable.

Experience
:
Two years of 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…