Revenue Cycle Representative (Prior Authorization) - Patient Access Management (PAM) - Patient Financial Services (PFS)

University of Iowa•Iowa City, IA

27d•Hybrid

About The Position

University of Iowa Health Care department of Patient Financial Services is seeking a Prior Authorization Revenue Cycle Representative (RCR) to join our team. The Prior Authorization Specialist is a financial clinical support healthcare position focused on delivering exceptional customer service. The Prior Authorization Specialist 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. The Prior Authorization Specialist will work in a high volume, fast-paced, web-based application environment and support a culture of 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. The Prior Authorization Specialist 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 eligible to participate in remote work within the state of Iowa and applicants who wish to work remotely will be considered. Training will be held either ONSITE or via ZOOM from the HSSB building at a length determined by the supervisor. Remote eligibility will be evaluated upon a satisfactory job training opportunity. 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. University of Iowa Health Care-recognized as one of the best hospitals in the United States-is Iowa's only comprehensive academic medical center and a regional referral center. Each day more than 12,000 employees, students, and volunteers work together to provide safe, quality health care and excellent service for our patients. Simply stated, our mission is: Changing Medicine. Changing Lives. WE CARE Core Values: Welcoming - We have an environment where everyone has a voice that is heard; that promotes the dignity of our patients, trainees, and employees; and allows all to thrive in their health, work, research, and education. Excellence - We achieve and deliver our personal and collective best in the pursuit of quality and accessible health care, education, and research. Collaboration - We collaborate with health care systems, providers, and communities across Iowa and the region as well as within our UI community. We believe teamwork-guided by compassion-is the best way to work. Accountability - We behave ethically, act with fairness and integrity, take responsibility for our own actions, and respond when errors in behavior or judgment occur. Respect - We create an environment where every individual feels safe, valued, and respected, supporting the well-being and success of all members of our community. Empowerment - We commit to fair access to research, health care, and education for our community and opportunities for personal and professional growth for our staff and learners.

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.
Knowledge of healthcare billing (healthcare revenue cycle); insurance, and/or federal and state assistance programs.
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.

Nice To Haves

Experience working in a complex hospital system is highly desirable.
Experience handling difficult callers, customers and patients.
Experience and knowledge of Patient Financial Services' functions, systems, processes & policies.
Demonstrated ability to maintain or improve established productivity and quality requirements.
Knowledge of medical terminology.
Knowledge of anatomy and physiology.
Knowledge of Health Insurance Portability and Accountability Act (HIPAA) laws.
Experience identifying opportunities for improvement and making recommendations and suggestions.
Experience with multiple technology platforms such as Epic, Cirius ACD, and/or GE.
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, 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 an 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.