The University of Iowa Hospitals and Clinics department of 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: to our external customers: patients, patient families, insurance contacts, etc; as well as internal customers (Nurses, Technicians, Physicians, and other UIHC staff).

The PAM 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 difficult situations. The PAM 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 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 ONSITE at the HSSB building at a length determined by the supervisor. Remote eligibility will be evaluated upon a satisfactory job training opportunity. Successful candidates must comply with requirements of the remote work program and related policies.

Position 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 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 pre-authorization denials and/or set-up peer to peer reviews.
• Collaborate with other departments to assist in obtaining pre-authorizations in a cross-functional manner.
• Contact patients and insurance companies for payment acquisition, pre-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 prior authorization/referral 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.

Classification Title: Revenue Cycle Representative

Specified Area: Prior Authorizations

Department: Patient Financial Services

Percent of Time: 100%

Pay Grade: 2B

Salary: $40,000 to $55,000

Location: Hospital Support Services Building (HSSB) located in Coralville, IA

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 ONSITE at the HSSB building at a length determined by the supervisor. Remote eligibility will be evaluated upon a satisfactory job training opportunity. Successful candidates must comply with requirements of the remote work program and related policies.