Position Summary:
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 Revenue Cycle Representative is a financial clinical support healthcare position focused on delivering exceptional customer service. The Prior Authorization Revenue Cycle Representative 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 Revenue Cycle Representative 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 Revenue Cycle Representative 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:
Position 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.
Classification Title: Revenue Cycle Representative (Prior Authorization)
Specified Area: Prior Authorizations
Department: Patient Financial Services
Percent of Time: 100%
Pay Grade: 2B
Location: Hospital Support Services Building (HSSB) located in Coralville, IA
This position is eligible to participate in remote work 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.
Equipment:
Education Required:
Experience Requirements:
Desirable Qualifications:
Application Process:
To be considered for an interview, applicants must upload the following documents and mark them as a "Relevant File" for the submission:
Job openings are posted for a minimum of 7 calendar days and may be removed from posting and filled any time after the original posting period has ended. Applications will be accepted until 11:59 PM on the date of closing.
Successful candidates will be required to self-disclose any conviction history and will be subject to a criminal background check and credential/education verification. Up to 5 professional references will be requested at a later step in the recruitment process.
Successful candidates will require a work arrangement form to be completed upon the start of your employment. 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.
For additional questions, please contact Zach Schmidt at zachary-e-schmidt@uiowa.edu.
Applicant Resource Center:
Need help submitting an application or accepting an offer? Support is available! Our Applicant Resource Center is now open in the Fountain Lobby at the Main Hospital.
Hours:
Visit the website for more information: Application Resource Center | University of Iowa Health Care
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