Revenue Cycle Representative - Ophthalmology

University of Iowa•Iowa City, IA

1d•Hybrid

About The Position

University of Iowa Health Care’s Department of Ophthalmology and Visual Sciences is seeking an entry-level Prior Authorization Revenue Cycle Representative (RCR) to join our team. Prior Authorization is a financial clinical support healthcare position focused on delivering exceptional customer service. This role is instrumental in ensuring a seamless experience for both external stakeholders—patients, their families, and insurance representatives—and internal partners, including nurses, technicians, physicians, and other staff at Iowa Health Care. Prior Authorization will work in a high volume, fast-paced, web-based application environment and support Service Excellence by delivering high quality customer service and maintaining composure in demanding situations. This position will primarily focus on performing prior authorization functions and insurance benefit coverage investigations. Prior Authorization must have a demonstrated ability to prioritize, multi-task, and quickly change focus in a dynamic team environment. The ability to exhibit compassion and empathy when collaborating directly with patients and/or their families is critical. A person in this role will provide consistent and comprehensive information (both in writing and verbally) to providers, clinical teams, patients, external entities and various administrative and management personnel regarding third party, patient billing and customer service activities. This position is primarily a combination of remote and onsite (hybrid) work locations. Remote work must be performed at an offsite location within the State of Iowa. Training will be held either on ONSITE at the Medical Campus University (MCU) building or via zoom, with location and length of training determined by the supervisor. Remote eligibility will be evaluated upon a satisfactory job training opportunity. Required quarterly meetings will be conducted on-site at MCU. Per policy, work arrangements will be reviewed annually and must comply with the remote work program and related policies and employee travel policy when working at a remote location.

Requirements

Bachelor’s degree or equivalent combination of education and relevant experience.
6 months or more of related customer service experience in a professional, financial or health care related environment.
Demonstrated ability to maintain or improve established productivity and quality requirements.
Knowledge of healthcare billing (healthcare revenue cycle); insurance, and/or federal and state assistance programs.
Experience with multiple technology platforms such as Epic, Cirius ACD, and/or GE.
Strong attention to detail and with accuracy to achieve or exceed organizational and individual performance goals.
Must be proficient in computer software applications, i.e., Microsoft Office Suite (Excel, Word, Outlook, PowerPoint) or comparable programs and an ability to quickly learn and apply new systems knowledge.
Demonstrated ability to handle complex and ambiguous situations with minimal supervision.
Self-motivated with initiative to seek out additional responsibilities, tasks and projects.
Effective communication skills (written and verbal), active listening skills and the ability to maintain professionalism while handling demanding situations with callers or customers.
Successful history collaborating in a fast-paced team environment.
Demonstrated experience working effectively with individuals from a variety of backgrounds and perspectives.

Nice To Haves

Experience working in a complex hospital system.
Experience handling difficult callers, customers and patients.
Knowledge of medical terminology.
Knowledge of Health Insurance Portability and Accountability Act (HIPAA) laws.
Experience identifying opportunities for improvement and making recommendations and suggestions.
Ability to drive results and foster accountability throughout the team and organization.
Maintain current awareness of industry trends and continually strive for improvement with both technical and professional skills.

Responsibilities

Ensure accurate validation of insurance eligibility, coverage details, network agreements, and financial obligations.
Obtain, track and complete prior authorizations for procedures, clinic visits, medications, validate imaging, testing, procedure meets insurance company medical necessity criteria across various specialties. This encompasses outpatient services and surgical/non-surgical procedures, whether elective, urgent, and same day.
Interact with physicians, nurses and clinical support staff on a case-by-case basis to obtain appropriate clinical documentation to ensure accurate indications in the patient’s medical record before completion of third-party prior authorizations. This may include contacting referring physicians for information.
Understand, anticipate, and respond to complex questions from clinical staff and insurance company nurse reviewer. When necessary, proactively contact third parties and initiate communication to ensure appropriate future payment.
Problem solves with insurance utilization review nurses, medical directors, providers, and other Iowa Healthcare staff to meet patient care needs. Identify and produce creative solutions to problems identified via the prior authorization process.
Appeal prior authorization denials and/or set-up peer to peer reviews.
Communicate with clinical teams on non-covered procedures/therapy/testing or exam coverage issues. Facilitate financial counseling for patients and families as directed by clinical team.
Assist with medical necessity documentation to expedite approvals, appeals and complete appropriate follow-up.
Utilize Epic to enter and track prior authorization information, retrospective reviews and denial follow-up efficiently/effectively.
Collaborate with other departments to assist in obtaining pre-authorizations in a cross-functional manner.
Maintain current knowledge of medical modalities as well as new protocols established for patient populations.
Maintain extensive working knowledge and expertise of insurance companies and billing authorization/referral requirements, clinical guideline policies, payer regulations, financial classifications and financial assistance programs.
Develop and maintain an effective, supportive working relationship with nurses, imaging techs, clinic/OR surgery schedulers, coders, fiscal teams, referral sources and external entities.
Communicate with providers, payers, patients, internal departments, co-workers and prior authorization leadership to resolve authorization denial issues.
Identify & report undesirable trends and reimbursement modeling errors or underlying causes of incorrect payment; review allowed variances from third party payers.
Maintain a high level of accuracy to meet productivity and quality requirements.
Review and analyze report data to provide status updates to leadership.
May perform other duties as assigned.