Top Patient Care Services Executive jobs in Iowa

Position Summary:

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 stakeholders—patients, their families, and insurance representatives—and internal partners, including nurses, technicians, physicians, and other staff at Iowa Healthcare.

The 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 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, 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 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.

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 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 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. 

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 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.

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.