The University of Iowa Healthcare, Department of Patient Financial Services, is seeking a Prior Authorization and Referral Revenue Cycle Representative (RCR) to join our team at the Medical Center Downtown (MCD) location. The RCR is a financial clinical support healthcare position focused on delivering exceptional customer service. The RCR 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 Healthcare.
The RCR 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 RCR 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.
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 are committed to ensuring that UI Health Care is an inclusive environment where individuals from the full spectrum of diversity - which includes identity, backgrounds, cultures, ability and perspective -feel safe, seen, and valued.
Equity - We dedicate ourselves to equity and fairness in research, health care, education and health.
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.
Location: Medical Campus Downtown, 500 E. Market St, Iowa City, IA
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 Hospital Support Services Building (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:
Onsite - The department will provide a workstation which contains 3 (three) monitors, laptop/power cord, docking station/power cord, keyboard, mouse, headset, and desk supplies can be found in the supply closet.
Hybrid - while working onsite, the department will provide a workstation which contains 3 (three) monitors, a laptop/power cord, docking station/power cord, keyboard, mouse, headset, and desk supplies. When working offsite, the employee will take their laptop/power cord to carry back and forth, a second docking station/power cord to keep offsite. Prior to working offsite, the employee, at their own expense, will need to supply 2 (two) monitors, a keyboard, a mouse, and provide a screen shot of the domicile internet speed (minimum 30mb download and 10mb upload) and a picture of the office setup.
Remote - when working offsite, the department will provide the employee a laptop/power cord, docking station/power cord, headset. Prior to working offsite, the employee, at their own expense, will need to supply 2 (two) monitors, a keyboard, a mouse, and provide a screen shot of the domicile internet speed (minimum 30mb download and 10mb upload) and a picture of the office setup.
Education Required:
Bachelor's degree or equivalent combination of education and relevant experience.
Experience Requirements:
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 demanding situations with callers or customers.
Successful history collaborating in a fast-paced team environment.
Desirable Qualifications:
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.
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.
Maintain current awareness of industry trends and continually strive for improvement with both technical and professional skills.
Application Process: To be considered for an interview, applicants must upload the following documents and mark them as a "Relevant File" for the submission.
Resume
Cover Letter
Job openings are posted for a minimum of 14 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 Veronica Clark at veronica-clark@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:
Monday 8:00 am - 10:00 am
Tuesday 8:00 am - 10:00 am
Wednesday 8:00 am - 1:00 pm
Thursday 8:00 am - 10:00 am
Friday 12:30 pm - 5:00 pm
Or by appointment - Contact TAHealthCareSupport@healthcare.uiowa.edu to schedule a time to visit.
