Customer Service Associate - Payor Relations

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.

Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.

General Description of the Job Class

The Payer Relations CSA serves as a centralized point of control and liaison for all payer-related communications, requirements, and escalations in the support of the revenue cycle.

Duties and Responsibilities of this Level

Escalation, Payer Research 85%

Act as the primary internal gatekeeper for our Payer Relations Escalation Submission Site from our internal stakeholders.

Review submissions for accurate documentation so analysts can properly work on the case. Send requests for additional information when necessary.

Will manage the group email box making sure communications reach the payer relations analyst.

Track all escalations submitted through the press site making sure the right documentation is received to follow up on requests.

Research payer policies for updates to make sure any new or emerging changes for commercial and federal payers.

Take notes during meetings making sure all takeaways are documented.

Making sure all key stakeholders are added to meetings.

Develop spreadsheets for proper documentation for any research or escalations that come up.

General 15%

Develop and maintain documentation summarizing workflow processes and operating policy & procedure for all functions relating to CSA position.

Develop and maintain a working and effective knowledge of all functions performed by team.

Develop and maintain a working knowledge of relevant payor billing requirements and reimbursement regulations and insurance plans.

Develop and maintain a working knowledge of all core systems (Maestro Care) and ancillary systems (Availity, Hyland, payor-specific portals, etc.) utilized by team.

Develop and maintain complete understanding of all operational policies and procedures relevant to team.

Develop and maintain working and proficient knowledge of personal computer software required for fulfilling responsibilities, including Outlook, Excel reporting, Word processing, Visio flowchart, PowerPoint presentation, ServiceNow Change Controls, I-forms, and API/PTO

Required Qualifications of this Level:

Education and Training:

High School Diploma.

Experience & Skills:

Minimum of four years of applicable Healthcare experience. Previous experience successfully managing complex projects involving multiple stakeholders with a consistent track record of delivering on time, or high-quality results preferred.

A Bachelors' degree in a related field can substitute two years of experience on a 1:1 basis.

General 15%

Develop and maintain documentation summarizing workflow processes and operating policy & procedure for all functions relating to CSA position.

Develop and maintain a working and effective knowledge of all functions performed by team.

Develop and maintain a working knowledge of relevant payor billing requirements and reimbursement regulations and insurance plans.

Develop and maintain a working knowledge of all core systems (Maestro Care) and ancillary systems (Availity, Hyland, payor-specific portals, etc.) utilized by team.

Develop and maintain complete understanding of all operational policies and procedures relevant to team.

Develop and maintain working and proficient knowledge of personal computer software required for fulfilling responsibilities, including Outlook, Excel reporting, Word processing, Visio flowchart, PowerPoint presentation, ServiceNow Change Controls, I-forms, and API/PTO

Required Qualifications of this Level:

Education and Training:

High School Diploma.

Experience & Skills:

Minimum of four years of applicable Healthcare experience. Previous experience successfully managing complex projects involving multiple stakeholders with a consistent track record of delivering on time, or high-quality results preferred.

A Bachelors' degree in a related field can substitute two years of experience on a 1:1 basis.