About Job

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 HomeCare & Hospice

Pursue your passion for caring with Duke HomeCare & Hospice, which offers hospice, home health, and infusion services across the region, as well as serves as the home forthe Duke Caregiver Support Program. Team members work closely with a patient's physician to provide comprehensive, individualized care in the comfort of their home or at our inpatient hospice facility in Durham, NC.

POSITION SUMMARY

Case Manager/liaison between the patient's payer source and all DHCH programs-Home Health, Hospice and Infusion. The Financial Care Counselor's role is to obtain the initial authorization for services being rendered by the DHCH programs. If re-authorization is required, in order for services to be continued, the Financial Care Counselor is involved in obtaining the additional authorization as well. This position plays a critical role in helping to ensure that DHCH programs will receive payment for the services they are performing when claims are filed to the payer source. This position must be able to work independently.

POSITION RELATIONS

Responsible to: Manager, Referral Center

POSITION RESPONSIBILITIES:

Ensures confidentiality of patient information through HIPAA Compliance.
Obtains authorizations based on insurance plan contracts and guidelines.
Documents in billing systems according to policy and procedure.
Communicates with payer sources and DHCH programs regarding clinical information requested, in order to obtain all authorizations.
Resolves issues related to obtaining authorizations from payer sources, so services can be rendered.
Notifies manager of any authorization concerns.
Communicates to manager any IT issues.
Runs the authorization expiration report in billing systems, and notifies the programs they need to determine if additional authorization is going to be needed.
Performs special projects as assigned and other duties as requested.

QUALIFICATIONS

The individual must be very detail-oriented and possess time management, analytical, and organizational skills. The individual must be able to work in a fast paced environment and meet deadlines and established goals. This individual must be able to work independently and have great focus. The individual must be accurate and efficient in performing their job duties.

EDUCATION AND TRAINING:

High school diploma or equivalent. Strong understanding of reimbursement guidelines, case management, medical terminology, coding, third party benefits and collection techniques. Must be computer literate.

WORK EXPERIENCE :

Work requires two years of experience in obtaining prior authorization certification and/or case management in a health care setting, and/or experience in billing and reimbursement.

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, pay sources, co-workers, and leadership. Must be able to understand and comply with policies and procedures.

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 onthe 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.