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

UIOWA•Iowa City, IA

1d•Hybrid

About The Position

Position Summary: University of Iowa Health Care department Patient Financial Services is seeking a Revenue Cycle Representative (RCR) for an entry-level customer service and financial related position in the health care industry. The Patient Access Management (PAM) Division RCRs will provide exceptional customer service to our external customers: patients, insurance contacts, etc; as well as internal customers. The PAM VA Referral 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 difficult situations. The PAM VA Referral 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 working 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 patients, outside agencies 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 strive for 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 aim to achieve and deliver our personal and collective best in the pursuit of quality and accessible healthcare, education, and research. Collaboration - We encourage collaboration with healthcare 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 proven ability to gather and analyze data and keep accurate records.
Proficiency with 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 difficult situations with callers or customers.
Successful history collaborating in a fast-paced team environment.

Nice To Haves

Experience handling difficult callers, customers, and patients.
Experience and knowledge of Patient Financial Services’ functions, systems, processes & policies.
Familiarity with medical terminology.
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.

Responsibilities

Review accounts, verify insurance coverage and initiate pre-certifications, pre-authorizations, referral forms and other requirements related to managed care; route to appropriate departments as needed.
Assist in monitoring utilization services to assure cost effective use of medical resources through processing VA referrals and prior authorizations.
Communicate with patients and/or referring physicians on non-covered benefits or exam coverage issues.
Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
Ensure insurance carrier documentation requirements are met and authorization/referral documentation is scanned and recorded in the patient’s medical record.
Appeal authorization denials and/or set-up peer to peer reviews.
Collaborate with other departments to assist in obtaining authorizations in a cross-functional manner.
Contact patients and insurance companies for payment acquisition, authorizations or to resolve patient account inquiries.
Provide financial counseling to patients and families; determine if appropriate payment has been made by various entities; work with patients and insurance companies to obtain correct payments; appeal claim payments and/or denials.
Collect demographic, insurance, and clinical information to ensure that all reimbursement requirements are met.
Maintain an extensive working knowledge and expertise of insurance companies and billing authorization/referral requirements.
Communicate with other referral/authorization specialists, patient account representatives and coders to continually monitor changes in the health insurance arena.
Identify & report undesirable trends and reimbursement modeling errors or underlying causes of incorrect payment; review allowed variances from third party payers.
Be expected to maintain a high-level of accuracy to meet productivity and quality requirements.
Identify trends and/or work processes for potential process improvements.
Review and analyze report data to provide status updates to leadership.
Communicate with providers, payers, patients, internal departments, co-workers, and Coordinator’s to resolve issues.
Maintain extensive working knowledge and expertise based around payer regulations/policies, financial classifications and financial assistance programs.
Build and maintain solid working relationships with clinical staff, referral sources, insurance companies, medical providers and public.