Healthcare Financial Care Counselor

Duke Eye Center of Winston Salem - Winston-Salem, NC

General Description

Accurately complete patient accounts based on departmental protocol,policies and procedures,and compliance with regulatory agencies, to include but not limited to pre-admission, admission, pre-registration and registration functions. Ensure all insurance requirements are met prior to patients' arrival and inform patients of their financial liability prior to arrival for services. Arrange payment options with the patients and screens patients for government funding sources.


1. Analyze insurance coverage and benefits for service to ensure timely reimbursement.

Obtain all Prior Authorization Certification and/or authorizations as appropriate. Facilitate payment sources for uninsured patients.
Determine if patient's condition is the result of an accident and perform complete research to determine the appropriate source of liability/payment.
Admit, register and pre-register patients with accurate patient demographic and financial data.
Resolve insurance claim rejections/denials and remedy expediently.
Enter and update referrals as required.
Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment
Document billing system according to policy and procedure

2. Explain bills according to PRMO credit and collection policies.Adheres to PRMO Cash Management Policies and Procedures.

Implement appropriate collection actions and assist financially responsible persons in arranging payment.
Make referral for financial counseling.
Determine necessity of third party sponsorship and process patients in accordance with policy and procedure.
Examine insurance policies and other third party sponsorship materials for sources of payment. Inform attending physician of patient financial hardship.
Complete the managed care waiver form for patients considered out of network and receiving services at a reduced benefit level. Update the billing system to reflect the insurance status of the patient.
Refer patients to the Manufacturer Drug program as needed for medications.
Explain policies and procedures, and resolves problems.
Gathers necessary documentation to support proper handling of inquiries and complaints

3. Greets and provides assistance to visitors.

Check-in patient upon arrival in the practice.
Identify correct patient information in Maestro Care.
Accurately identify the appropriate account for patient visit.
Present and educate patients on required forms and obtain signature as required by policy and procedure.
Completes all Maestro Care check-in files and manage all appropriate alerts.
Imprint all patient specific chart documents and requisition/transmittal documents.
Copy, file and distribute insurance cards as indicated by procedure.
Coordinate all labs/procedures as requested.
Maintain private physician office charts.

4. Check-out patients.
Make return appointments by scheduling patients into the correct appointment type, entering the primary care physician or referring physician and scheduling tests and procedures.
5. Answer telephone, take and deliver messages to physicians, nurses and others.
6. Report obtained medical information from patients and referring physicians accurately, completely and timely.
Disseminate messages according to practice communication standards
7. Labeling and scanning external documents into EMR.


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, physicians, co-workers and supervisors.
Must be able to understand and comply with policies and procedures.
Knowledge of EPIC a plus


Work requires knowledge of basic grammar and mathematical principles normally required through a high school education, with some post secondary education preferred.
Additional training or working knowledge of related business.

Two years' experience working in hospital service access, clinical service access, physician office or billing and collections. Or, an Associate's degree in a healthcare related field and one year of experience working with the public. Or, a Bachelor's degree and one year of experience working with the public

Must be able to work under time pressures in a busy clinic/office environment.
Must be present on site for 8 hour shifts during standard business hours.
Must participate in group activities requiring interpersonal skills & cooperation.
Must work as late person when scheduled or according to business needs
Must be able to react quickly and immediately respond to emergencies.
Must be able to handle multiple assignments,conflicting demands & priorities.
Must maintain attention to detail over extended period of time.
Must be continually aware of variations in changing situations.
Must be able to move throughout office environment throughout day.
Must be able to lift 30 lbs.
Must be able to push/pull 30 lbs.
Must be able to carry 30 lbs.
Must be able to reach for objects by extending arms.



Duke Eye Center of Winston Salem

Duke Eye Center of Winston Salem

Winston-Salem, NC