Patient Privacy Compliance Specialist
Bluesight
Financial Care Counselor
Duke Careers
full-time
Posted on:
Origin: • 🇺🇸 United States • North Carolina
Visit company websiteJob Level
JuniorMid-Level
About the role
- Case Manager/liaison between the patient’s payer source and all DHCH programs—Home Health, Hospice and Infusion; 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.
Requirements
- 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 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.
- 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.
