Pharmacy Prior Authorization Revenue Cycle Representative (IVF/REI), Iowa City or Urbandale (Hybrid)

The Pharmacy Prior Authorization Revenue Cycle Representative works to support patients in obtaining insurance coverage for in-vitro fertilization and reproductive endocrinology pharmacy medications covered under both the medical and pharmacy benefit. The position will also provide ancillary support to outpatient administered medications administered at the Urbandale UI Health Care location. The role will primarily focus on performing benefits investigations providing prior authorization support and researching patient financial assistance options such as copay assistance and grant programs. 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 service skills. The Pharmacy Prior Authorization Revenue Cycle Representative will work closely with a wide variety of staff within the health system to assist patients in gaining timely access to medications.

Position Responsibilities

Patient Revenue Management:

Assist patients and staff with benefits investigation and enrollment of patients into pharmacy services.

Communicate with patients pharmacists and/ or providers to gather relevant demographic information.

Initiate and follow through for required prior authorizations which may include pharmacy or medical authorizations.

Assist clinical pharmacy specialists or other providers with initiation of appeals when applicable.

Assist with copay/coinsurance assistance when applicable.

Appeal/troubleshoot claim payments and/or denials using available resources.

c)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.

f)Assist with the resolution of patient shipment issues in a timely manner.

Provide refill management calls and follow up to patients when assigned.

h)Assist Specialty Pharmacy and external pharmacy staff with the resolution of claims issues.

Provide the highest customer service experience for patients and providers.

Operations and Performance Standards:

Utilize tools and processes to maximize the efficiency of the revenue cycle.

Resolve pharmacy billing discrepancies and identify possible trends.

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.

Assist with the evaluation and implementation of new policies and procedures.

Participate in standard pharmacy operations as the need arises.

Reporting:

a)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:

a)Communicate with providers payors patients co-workers supervisors and departments to resolve 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.

Complete and maintain compliance with all competencies and educational requirements.

Other duties as assigned