Reimbursement Specialist - Outpatient Medication Authorization - Remote - MUST R

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.

Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is the 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 for Duke Health.

REMOTE POSITION: Monday - Friday (First Shift)

General Description of the Job Class

Compile, analyze and report on the performance of departmental operating units, noting trends and making recommendations or conclusions regarding progress.

Work Performed

• Analyze and provide feedback for departmental specific reports.
• Utilizes clinical and coding knowledge to ensure accurate and compliant charge items and to recognize and resolve billing inconsistencies.
• Coordinates projects and audits to improve processes related to revenue cycle, efficiency of charging and billing, and collection efforts.
• Assist management in forecasting by providing historical information.
• Work with departmental directors, managers and appropriate personnel to ensure budgetary compliance.
• Manage appropriate systems for accounts receivable and/or financial reporting and prepare written reports and analyses for PRMO, DUHS and PDC leadership documenting trends and appropriate recommendations/conclusions.
• Coordinate communication between insurance companies, governmental agencies, providers and support staff.
• Trend and report on departmental performance indicators and goals.
• Ensure departmental goals are satisfied.
• Make recommendations to improve financial systems; perform in house audits of operating units; analyze deficiencies and report to manager/director.
• Assist in developing and defining short and long term departmental specific goals and objectives.
• May be responsible for managing and delegating database inquiries.
• Creation and development of work assignments including training of employees.
• Maintain professional relationship with internal and external agencies and professional organizations concerning operations.
• May serve as liaison between the physicians and the PRMO.
• May conduct employee quality reviews in support of OER (Overall Effectiveness Rating) performance evaluations, and provide feedback to management and relevant employees.
• Develop and provide job-specific training to new and existing employees within department.
• Perform other related duties incidental to the work described herein.

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 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 (including pregnancy and pregnancy related conditions), sexual orientation or military 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.

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.

Originally posted on Himalayas