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Prior Authorization Revenue Cycle Representative – Patient F… Jobs in Iowa City at The University of Iowa


Title: Prior Authorization Revenue Cycle Representative – Patient F…

Company: The University of Iowa

Location: Iowa City

The University of Iowa Hospitals and Clinics department of Patient Financial Services is seeking a Revenue Cycle Representative (RCR) for an entry-level customer service and financial related position in the health care industry. The Patient Access Management (PAM) Division RCRs will provide exceptional customer service to our external customers: patients, insurance contacts, etc; as well as internal customers.
The PAM Prior Authorization Specialist 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 difficult situations. The PAM Prior Authorization Specialist 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 working 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 patients, outside agencies and various administrative and management personnel regarding third party, patient billing and customer service activities.

Position Responsibilities:

Review accounts, verify insurance coverage and initiate pre-certifications, pre-authorizations, referral forms and other requirements related to managed care; route to appropriate departments as needed.

Assist in monitoring utilization services to assure cost effective use of medical resources through processing prior authorizations.

Communicate with patients and/or referring physicians on non-covered benefits or exam coverage issues.

Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.

Ensure insurance carrier documentation requirements are met and authorization/referral documentation is scanned and recorded in the patient’s medical record.

Appeal pre-authorization denials and/or set-up peer to peer reviews.

Collaborate with other departments to assist in obtaining pre-authorizations in a cross-functional manner.

Contact patients and insurance companies for payment acquisition, pre-authorizations or to resolve patient account inquiries.

Provide financial counseling to patients and families; determine if appropriate payment has been made by various entities; work with patients and insurance companies to obtain correct payments; appeal claim payments and/or denials.

Collect demographic, insurance and clinical information to ensure that all reimbursement requirements are met.

Maintain an extensive working knowledge and expertise of insurance companies and billing authorization/referral requirements.

Communicate with other prior authorization/referral specialists, patient account representatives and coders to continually monitor changes in the health insurance arena.

Identify & report undesirable trends and reimbursement modeling errors or underlying causes of incorrect payment; review allowed variances from third party payers.

Be expected to maintain a high-level of accuracy to meet productivity and quality requirements.

Identify trends and/or work processes for potential process improvements.

Review and analyze report data to provide status updates to leadership.

Communicate with providers, payers, patients, internal departments, co-workers and Coordinator’s to resolve issues.

Maintain extensive working knowledge and expertise based around payer regulations/polic…

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