Reimbursement Specialist - Outpatient Medication Authorization - 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 (8am - 5pm)

*** MUST RESIDE IN NORTH CAROLINA***

General Description of the Job Class:

Pre-Service Verification is an integral part of the revenue cycle, responsible for the verification of patient insurance eligibility, prior authorization, and medical necessity for physician and hospital inpatient and outpatient services provided across Duke Health.

This position is responsible for the quality review of internal and external staff completing insurance verification, benefit collection, and pre-authorization and provides support to supervisors in staff education and training. This position supports management and supervisors i n overseeing outsourced vendor books of business to ensure inventory, productivity, quality guidelines are achieved and maintained.

Duties and Responsibilities of this Level:

Quality Auditing 50%

• Perform regular quality audit/control reviews on internal and external staff according to department policies and procedures. Requires review of authorization denials and analysis to determine/assign root-cause.

• Maintain electronic documentation files to record all quality scores, maintaining compliance guidelines.

• Trend and report overall quality scores and feedback on the team’s performance.

• Meet with management regularly to share audit findings and results.

• Respond to audit questions/discrepancies timely and in accordance with department policies and procedures.

Outsourcing Support 40%

• Support management/supervisors in overseeing outsourced vendor books of business to ensure inventory, productivity, and quality guidelines are achieved and maintained as defined by department contracts. < /span>

• Aid in the oversight of work queue inventories, productivity/quality reporting, and confirmation of monthly invoicing.

• Respond to external staff questions timely regarding accounts or process as defined by department policies and procedures.

• Communicate process changes and training to vendors as needed.

• Attend and participate in regularly scheduled meetings with outsourced vendors as assigned.

Other Specific Duties 10%

• Research accounts and respond with accurate findings/instructions in a timely manner.

• Interact with and provide verbal/written responses to all stakeholders (patients, providers, payors, and departmental personnel).

• Participate in the development of operational goals and objectives for the team; recommend, implement, and administer processes and procedures to enhance workflow.

• Assist management in training documentation related to findings from quality reviews/audits.

• At tend and/or facilitate regular training sessions to maintain knowledge of practice/protocol related to timely filing adjustments as needed.

• Partner with supporting clinics to educate on authorization processes and resolve problems relating to patient appointments/admissions as needed.

• Conduct observations of staff/process to look for operational improvements and share recommendations with management.

• Acknowledge management requests and emails in a professional, timely manner.

• Attend meetings and participate on committees as assigned.

• Actively participate in Work Culture initiatives.

• Accomplish all tasks as assigned.

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.

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.