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

University of Iowa•Iowa City, IA

20h•Hybrid

About The Position

University of Iowa Health Care’s department of Patient Financial Services is seeking a 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 HSSB 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. 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.
Customer service experience (typically 6 months or more) in a healthcare, call center, financial, retail, or other professional service environment, with a strong focus on providing clear, courteous, and respectful service.
Ability to communicate confidently and professionally with patients, family members, and team members by phone and electronic communication.
Strong attention to detail and the ability to accurately collect, verify, and document demographic and insurance information.
Experience using Microsoft applications such as Outlook, Excel, Word, OneNote, and Teams to support daily work activities, along with the ability to learn new systems efficiently.
Ability to work in a fast paced environment, manage multiple tasks, and remain organized while meeting quality and accuracy expectations.
Demonstrated reliability, professionalism, and a commitment to protecting confidential information, including patient privacy.

Nice To Haves

Experience working in a call center or high-volume phone environment, including handling inbound and/or outbound customer service calls.
Experience delivering customer service in challenging or sensitive situations, such as resolving concerns or supporting customers who may be stressed or frustrated.
Basic knowledge of medical insurance or healthcare billing.
Experience using Epic or another electronic health record (EHR) system.
Knowledge of or experience working under HIPAA or other confidentiality regulations.
Demonstrated ability to meet productivity and quality goals while maintaining a positive and patient centered experience.

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.