Revenue Cycle Coordinator

The Revenue Cycle Coordinator is a financial position in the healthcare industry necessary for hospital and pharmacy billing practices. This position requires strong computer skills a high level of attention to detail strong organizational skills a general knowledge of hospital and prescription billing practices and excellent customer services skills. This position will work closely with other staff within the hospital and Specialty Pharmacy leadership to support and lead pharmacy revenue processes and pharmacy medical revenue (i.e. training and support to benefits investigation prior authorization and copay assistance staff) serve as a resource for complex pharmacy billing activities and assist in the management of patient refill coordination. The Revenue Cycle Coordinator will also coordinate with pharmacists pharmacy practice specialists pharmacy management and the UI Health Care Specialty Quality Committee for quality assurance checks productivity audits and quality improvement projects. This position in conjunction with pharmacy management will also provide direction feedback and coaching to staff members to help ensure excellent patient outcomes and exemplary patients satisfaction are achieved. The position will also work with the pharmacy leadership central prior authorization team to support the continued expansion of central prior authorization services to outpatient clinics throughout the health system.

Position Responsibilities

• Human Resources Management:
  • Participate in regular coaching and evaluation of employee performance.
  • Provide feedback to technician supervisor regarding employee performance.
  • Provide direction to employees faced with new and/or complex billing or benefits investigation issues.
  • Provide direction to team leads to allow them to assist the team with complex issues supplementary training and workflow improvement

• Patient Revenue Management:
  • Serve as resource in assisting staff with both routine and complex benefits investigations and enrollment of patients into pharmacy services (i.e. specialty pharmacy).
    • Communicate with patients pharmacists and/ or providers to gather relevant demographic information.
    • Initiate and follow through for required prior authorizations.
    • Assist clinical pharmacy specialists or other providers with initiation of appeals when applicable.
    • Assist with copay/coinsurance assistance when applicable.
  • Communicate with patients insurance companies credit/collections for payment acquisition pre-authorization and to resolve patient account inquiries.
  • Appeal/troubleshoot claim payments and/or denials using available resources.
  • Provide accurate documentation of all activities as required by accrediting agencies payers and/or administration.
  • Monitor reimbursement activity for medications to ensure UI Health Care receives full and accurate reimbursement for pharmacy services in compliance with payor rules and regulations.
  • Monitor compliance standards and policies to ensure UI Health Care receives full and accurate reimbursement for services in compliance with payor rules and regulations.
  • Assist with the resolution of patient shipment issues in a timely manner.
  • Provide refill management calls and follow up to Specialty Pharmacy patients when assigned.
  • Assist Patient Management Team with the resolution of claims issues.
  • Provide the highest customer service experience for patients and providers.

• 3) Operations and Performance Standards:
  • Assist with the regular review of employee documentation in order to meet quality and accreditation standards.
  • Utilize and identify billing tools and processes to maximize the efficiency of the revenue cycle.
  • Assist staff in resolving pharmacy billing discrepancies and identify possible trends where new process development and/or staff education is needed.
  • Assist with the implementation of new Specialty Pharmacy services projects and initiatives.
  • Serve on the Specialty Pharmacy Services Quality Management Committee.
  • Solicit feedback from staff to improve processes.
  • Identify areas to improve the billing process.
  • Identify areas to improve the benefits investigation and prior authorization process.
  • Comply with established cash handling policies and procedures of the institution and department.
  • Assist with the evaluation and implementation of new products/technology.
  • Participate in standard pharmacy operations as the need arises.

• Reporting:
  • Analyze and prepare routine reports to identify trends and aid in making financial decisions.
  • Compile information for audits as they arise from compliance and insurance/third party payors in a reportable manner.
  • Report discrepancies found during report analysis.
  • Document activities required by accrediting agencies payors and/or administration (i.e. workload statistics phone statistics etc.)

• Communication/Training:
  • Work with Specialty Pharmacy technician supervisor to develop and maintain formalized staff training education and competency programs.
  • Train all new employees on essential daily functions for specialty operations.
  • Coordinate follow up at the end of new employee training to ensure the employee is able to fully perform job duties.
  • Develop a mechanism to share daily team workload with the entire team.
  • Coordinate daily staffing and step in where needed depending on workload needs.
  • Act as primary liaison in communicating with providers payors patients co-workers supervisors and departments to resolve complex revenue cycle issues.
  • Understand the importance of effective business communication and maintaining professionalism in difficult situations.
  • Participate in orientation of pharmacy technicians pharmacists pharmacy residents and others within the department on pharmacy billing practices.

• Other duties as assigned