Provide outreach and care management support to patients; educate clients of available community resources. Assist clients with coordination of care between healthcare providers and other complex care team(s).Performs a range of non-clinical care management functions (outreach, health education, informal counseling, social support, resource linkages, interpretation/ translation, transportation coordination, and advocacy) for an active patient caseload to build individual and community capacity by increasing health knowledge and self-sufficiency and accurately documents activities with follow-up and plans of action.Act as a client advocate and support the development of problem solving skills; provide instructions in basic health Maintain liaison with other programs, offices and departments at Duke to coordinate program business and to accomplish program objectives. Interface with external organizations as appropriate to ensure cooperative efforts are enhanced and available resources are utilized. Promote program on key coalitions and task forces to foster collaboration, educate constituencies, leverage resources, and reduce duplication of services.Monitor and evaluate program effectiveness, investigate trends, and recommend and implement modifications to improve program effectiveness. Prepare reports and Additional -- Collect and analyze key statistics (disease registries, biometrics, care management productivity, etc.) to ensure adherence to established care management protocols and benchmarks and investigates methods for improving service

Analyze insurance coverage and benefits for service to ensure timely.Obtain authorizations based payment on insurance plan contracts and guidelines.Document billing system.Explain bills provides assistance to visitors and patients.Explain policies and departmental coverage as requested.Calculate and according to PRMO credit and collection policies.Implement appropriate collect cash payments appropriately for all patients.Reconcile daily necessity of third party sponsorship and process patients in accordance 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.Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy.Perform those duties necessary to ensure all accounts are processed accurately and efficiently.Compile departmental statistics for budgetary and reporting purposes.Collection actions and assist financially responsible persons in arranging payment.Examine insurance policies and other third party sponsorship materials for sources of payment.Inform attending physician of patient financial hardship.Update the billing system to reflect the insurance status of the patient.Refer patients to the Manufacturer Drug program as needed for medications.Greet and procedures, and resolves problems.Enter and update referrals as required.Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage

Prepare for clinic visits by reviewing next day patients and completing next day preparation activities.Enter pre-visit orders and prepare new patient charts. Pick up X-rays, office charts, medical records, reports, petty cash and collections bag.File history sheets, ancillary reports and all other required patient record documentation.Return medical records.Attach HIPPA/Medicare documents to the encounter forms.Check-in patient upon arrival in the practice.Identify correct patient information in Maestro Care. Verify patient demographic data.Edit Maestro Care as needed.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.Collect and post co-payments and balances on accounts due.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.Prepare encounter forms.Investigate and account for missing encounter forms.Audit encounter forms for completeness and accuracy before batching.Batches encounter forms or charge posting in Maestro Care.Schedule tests and procedures.Complete and distribute ancillary service requisitions.Explain billing to patients according to PRMO credit and collection policies.Determine the amount of cash to be collected based on insurance plan.Check- outpatients.Make return appointments by scheduling patients into the correct appointment type, entering the primary care physician or referring physician and scheduling tests and procedures.