PRMO:, established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke PrimaryCare. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke's reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.
*** ONSITE POSITION: Monday - Friday ****
Gen Code Test Billing
Analysis of l ab test orders in relation to contracts with external labs for billing a nd application of CMS rules and contractual obligations. Ensure informat ion provided by Referral Lab Technologists is correct (QA billing, infor mation provided with requisitions, such as patient insurance, date, etc. Ensure correct price and CPT codes for the test that has been ordered). Applying CMS rules for billing determination. Ensure correct billing information is provided to external laboratories. Ensure correct account i nformation is included for claims. Enter the appropriate CPT codes and p rices for Gen Code test billing using EPIC work ques .
HB and PB Claim Edits
Clear 15 PB and 2 HB Clinical Lab claim edits to ensure correct and timely billing for tests to reduce the risk of denials and unexpected bills for the patient .
Perform prior author izations on Molecular tests for UH, BCBS, Tricare.
Prepare spreadsheet with new Referral Lab Molecular tes ts for the UHC registry for prior authorizations and maintain test accur acy of the registry.
Perform price estimates on G en Code tests for Duke Clinics throughout the Health System.
Work requires knowledge of basic grammar and mathematical principles normally required through a high school education, with some postsecondary education preferred.Additional training or working knowledge of related business
Two years experience working in hospital access, physician office or billing and collections or an equivalent combination of relevant education and/or experience.
Degrees, Licensures, Certifications
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.
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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.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.
To improve the patient experience by providing health care providers; patients and their families; and others with information, education, networking opportunities, and related resources focused on best practices.