Pharmacy Prior Authorization Revenue Cycle Representative

The Department of Pharmaceutical Care is seeking a full-time Prior Authorization Revenue Cycle Representative to join our team. The Pharmacy Prior Authorization Revenue Cycle Representative works to support patients in obtaining insurance coverage for outpatient pharmacy medications. The position 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 services skills. The Pharmacy Prior Authorization Revenue Cycle Representative will work closely with other staff within the health system to assist patients in gaining timely access to medications. This position is located off the main campus at our Wells Fargo Building in Coralville.

Duties To Include

• Other duties as assigned
• Communication/Training:
• Provide the highest customer service experience for patients and providers.
• Appeal/troubleshoot claim payments and/or denials using available resources.
• Assist Specialty Pharmacy and external pharmacy staff with the resolution of claims issues.
• Comply with established cash handling policies and procedures of the institution and department.
• Understand the importance of effective business communication and maintaining professionalism in difficult situations.
• Reporting:
• Assist with copay/coinsurance assistance when applicable.
• Communicate with patients, pharmacists and/ or providers to gather relevant demographic information.
• Assist with the resolution of patient shipment issues in a timely manner.
• Initiate and follow through for required prior authorizations, which may include pharmacy or medical authorizations.
• Communicate with providers, payors, patients, co-workers, supervisors and departments to resolve revenue cycle issues.
• Provide refill management calls and follow up to Specialty Pharmacy patients when assigned.
• Document activities required by accrediting agencies, payors and/or administration (i.e. workload statistics, phone statistics, etc.).
• Resolve pharmacy billing discrepancies and identify possible trends.
• Report discrepancies found during report analysis.
• Identify areas to improve the billing process.
• Participate in orientation of pharmacy technicians, pharmacists, pharmacy residents and others within the department on pharmacy billing practices.
• Identify areas to improve the benefits investigation and prior authorization process.
• Provide accurate documentation of all activities as required by accrediting agencies, payers and/or administration.
• Patient Revenue Management:
• Compile information for audits as they arise from compliance and insurance/third party payors in a reportable manner.
• Communicate with patients, insurance companies, credit/collections for payment acquisition, pre-authorization and to resolve patient account inquiries.
• Utilize tools and processes to maximize the efficiency of the revenue cycle.
• Analyze and prepare routine reports to identify trends and aid in making financial decisions.
• 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.
• Operations and Performance Standards:
• Assist clinical pharmacy specialists or other providers with initiation of appeals when applicable.
• Assist patients and staff with benefits investigation and enrollment of patients into pharmacy services (i.e. specialty pharmacy).
• 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 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.

Education Requirements

• Completion of a Bachelor’s degree or equivalent combination of education and experience.
• Successful completion of the pharmacy technician certification exam within twelve months of the start of employment.

Experience Requirements

• Demonstrate effective problem solving abilities and meets challenges with resourcefulness.
• Strong attention to detail and proven ability to gather and analyze data and keep accurate records.
• Self-motivated with initiative to seek out additional responsibilities and tasks along with generating suggestions for improving workflow.
• Previous experience in customer service
• Experience and proficiency with computer software applications (i.e. Microsoft Office Suite – Word, Excel, Outlook, PowerPoint) or comparable programs.
• Effective verbal and written communication skills, active listening skills and the ability to maintain professionalism while handling difficult situations.
• Familiarity with medical terminology.

Desired Qualifications

• Knowledge of healthcare billing, experience working with insurance and/or federal and state assistance programs is desirable.
• Experience working in a collaborative team environment is desirable.
• Experience working with multiple technology platforms (i.e. Epic, GE) is desirable.
• Knowledge and understanding of the Health Insurance Portability and Accountability Act (HIPAA) is desirable.
• Pharmacy experience is desirable.
• Experience working in a complex hospital system is highly desirable.

Position And Application Details

In order to be considered for an interview, applicants must upload the following documents and mark them as a “Relevant File” to the submission:

• Resume
• Cover Letter

Job openings are posted for a minimum of 14 calendar days and may be removed from posting and filled any time after the original posting period has ended.

Successful candidates will be subject to a criminal background check and credential/education verification. Up to 5 professional references will be requested at a later step in the recruitment process.

For additional questions, please contact Jenna Lueth at [email protected].

Additional Information

• Classification Title: Revenue Cycle Representative
• Schedule: Full-time
• Appointment Type: Professional and Scientific

Compensation

• Pay Level: 2B

Contact Information

• Contact Name: Jenna Lueth
• Contact Email: [email protected]
• Organization: Healthcare