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Durham, North Carolina, United States · On-site
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Durham, North Carolina, United States · On-site
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Durham, North Carolina, United States · On-site
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Durham, North Carolina, United States · On-site
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Durham, North Carolina, United States · On-site
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Durham, North Carolina, United States · On-site
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Durham, North Carolina, United States · Remote OK
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Durham, North Carolina, United States · Hybrid
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Durham, North Carolina, United States · On-site
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Durham, North Carolina, United States · On-site
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Durham, North Carolina, United States • On-site
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Manage the patient intake and triage process for non-critical transfers into the health system, ensuring appropriate care levels and financial screening. Coordinate with physicians and clinical staff to secure authorizations and reconcile surgical cases with billing systems.
Requires a Bachelor of Science in Nursing (BSN) and a valid North Carolina Registered Nurse (RN) license. Candidates must have at least 3 years of nursing experience and working knowledge of ICD-9/CPT-4 coding.
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.
Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States. The largest of the four Duke Healthhospitals with 1062 patient beds, it features comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.
Manage patient intake process (including patient triage and admissions) for non-critical transfer patients into Duke University Health System from referring hospitals, clinics, and physicians offices, ensuring appropriate level of care and financial screening.
Evaluate appropriate level of patient care, utilizing expert level clinical decision making to determine severity of illness for all elective, urgent and emergent admissions. Requires expert level analysis of patient clinical information and formulation of an accurate assessment of the patient and his/her condition. Coordinate with patient, physicians, nursing and/or clinical staff when requirements of admission are not met/authorized, requiring facilitation of alternative care arrangements, physician/administrative override, or delay in service. Responsible for collecting accurate and viable patient insurance information, and escalating all self-pay patients through the appropriate financial screening process (i.e. POMC, Medicaid, Charity Care, patient liability). Coordinate with physician, nursing and/or clinical staff in determining that the following have all been secured: (1) referral authorizations, (2) prior approval of specific treatments and surgical procedures, and (3) second surgical opinions of specific treatment/surgical procedures. Analyze clinical and financial information received on proposed admissions for coding accuracy, difficulty in obtaining authorization, and potential for financial issues . Initiate and facilitate pre-admission and pre-certification authorizations, requiring the detailed evaluation of clinical documentation. Responsible for ensuring all scheduled surgical cases are reconciled with the appropriate billing system. Ensure inpatient vs. outpatient scheduling criteria are met in accordance with published payer CPT lists. Enter detailed documentation of actions and outcomes in applicable billing system. Health System resourcefor coding of ICD-9 diagnoses/procedures, CPT-4 procedures, DRG, & APC assignment. Trainer and preceptor of Pre-Registration staff in ensuring their clinical knowledge needed to fulfill their position responsibilities. Provide quality assurance reviews of Pre-Registration staff work, ensuring internal controls are met. Conduct denial appeal follow-up, through analysis of clinical documentation to support level of care provided and secure reimbursement. Clinical and health care financial resource to PRMO and broader health system membership. Expert in medical terminology and clinical data interpretation. Liaison to all hospital and PDC departments and their staff members, including physicians, clinical nurses, Patient Resource Managers, clinic staff and bed control. Liaison to Patient Service Representatives, Billers, Collectors, internal and external Case Managers/Patient Resource Managers, Social Workers, and Discharge Planners. Perform other related duties incidental to the work described herein.
Excellent communication skills; written and verbal. Excellent customer service skills, including phone etiquette. Ability to establish good working relationships with associate departments. Working knowledge of ICD-9/CPT-4 coding.
Excellent communication skills; written and verbal. Excellent customer service skills, including phone etiquette. Ability to establish good working relationships with associate departments. Working knowledge of ICD-9/CPT-4 coding.
BSN Required
3 years of nursing experience
R.N. licensure and North Carolina State Licensure required.
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 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.
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.
Duke Health Technology Solutions is a robust, specialized division of Duke University Health System dedicated to the development and management of enterprise IT systems. A 2018 Davies Award Recipient, Duke Health is nationally recognized for IT and information management as the first healthcare system to be awarded top honors by the Healthcare Information and Management Systems Society (HIMSS) for inpatient, ambulatory and analytics health information technology capabilities. As a ‘Most Wired’ health system, our employees are among the top-skilled IT experts in the Triangle and work with leading scholars and researchers across Duke University to develop innovative technologies that support our mission of delivering tomorrow's healthcare today.
Offices: 2424 Erwin Road, Durham, NC 27715, US
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