Revenue Cycle Representative (Prior Authorization) - Patient Access Management (PAM) - Patient Financial Services

The University of Iowa Healthcare Department of Patient Financial Services is seeking a Prior Authorization Revenue Cycle Representative (RCR) to join our team. The Prior Authorization Specialist is a financial clinical support healthcare position focused on delivering exceptional customer service. The Prior Authorization Specialist is instrumental in ensuring a seamless experience for both external stakeholderspatients their families and insurance representativesand internal partners including nurses technicians physicians and other staff at Iowa Healthcare.

The Prior Authorization Specialist will work in a high volume fastpaced webbased 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 Specialist must have a demonstrated ability to prioritize multitask 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 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 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 teamworkguided by compassionis 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 wellbeing 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.

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/nonsurgical procedures whether elective urgent and same day.
• Interact with physicians nurses and clinical support staff on a casebycase basis to obtain appropriate clinical documentation to ensure accurate indications in the patients medical record before completion of thirdparty 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 solve 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 setup peer to peer reviews.
• Communicate with clinical teams on noncovered 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 followup.
• Utilize Epic to enter and track prior authorization information retrospective reviews and denial followup efficiently/effectively.
• Collaborate with other departments to assist in obtaining preauthorizations in a crossfunctional 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 requirementsclinical 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 coworkers 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 highlevel of accuracy to meet productivity and quality requirements.
• Review and analyze report data to provide status updates to leadership.

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 within the state of Iowa and applicants who wish to work remotely will be considered. Training will be held eitherONSITE or via ZOOM from the HSSB building at a length determined by the supervisor.

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.