Revenue Cycle Representative - Cancer Center

The Holden Comprehensive Cancer Center at the University of Iowa is seeking a Revenue Cycle Representative at Holden Comprehensive Cancer Center works with a multidisciplinary team of health professionals and administrators to facilitate financial aspects of the patient’s health care experience. They are responsible for performing benefit investigations, securing prior authorization for treatment and other visits, procedures and tests along with follow-up on denials and appeals of related decisions.  The Revenue Cycle Representative supports the generation of estimates for care to be provided, communicates with patients, insurers and the care teams about financial authorization needed and facilitates supporting documentation when needed.  The position may also support inquiries for financial navigation and work with the care team and other departments regarding drug replacement and copay assistance programs.  The Revenue Cycle Representative works in a fast-paced, high volume environment multitasking between telecommunication and web-based applications delivery a high level of customer service in a timely manner.

This position is eligible for a hybrid work arrangement of both on-campus (UI Health Care) and remote work within the state of Iowa upon completion of a training period, with the majority of work taking place on the U of I/UI Health Care campus.  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.

Duties to include:

•    Ensure all patient services are financially secured by completing insurance notification prior to services rendered.
•    Contact patients, insurance companies, care teams and other groups within the revenue cycle to ensure pre-authorization is complete and patient account inquiries are resolved.
•    Analyze and verify patient demographic, insurance eligibility and financial information/responsibility for accurate claim submission and reimbursement.
•    Participate in financial counseling for 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. Provide expense estimates to patients regarding office visits, procedures, diagnostic testing, surgery, etc.
•    Identify and 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.
•    Identify trends and/or work processes for potential process improvements. Review and analyze report data to provide status updates to leadership.
•    Build and maintain solid working relationships with clinical staff, referral sources, insurance companies, medical providers and public.
•    Assign CPT, HCPCS and/or ICD-10 codes for provided services. Review and assess medical record documentation to support codes and/or identify missed professional and technical billing opportunities.
•    Audit medical record documentation to ensure the professional and technical services billed comply with CPT, HCPCS and/or ICD10 guidelines and third-party payors’ documentation requirements.
•    Communicate with physicians (resident and staff) and other professionals who bill third party payors to resolve situations where the recommended-billed service is not supported in the medical record and/or not consistent with CPT, HCPCS and/or ICD10 guidelines and third-party payors’ documentation requirements.
•    Review and apply third party payor (Medicare, Medicaid, Wellmark, etc) billing regulations and compliance program standards. Assist in the design and development of systems for the capture of charge data and reimbursement data with regard to medical services.
•    Investigate and obtain required authorizations or referrals for services when necessary, including but not limited to, radiology services, infusion services, pharmaceutical services, professional services.
•    Assist Social Service and Pharmacy staff in enrolling patients in drug replacement, co-insurance assistance programs and/or other aid programs.
•    Provide support for other members of the revenue cycle in Patient Financial Services by helping investigate and resolve hold bills, claim denials, TES edits, CIRIUS and other edits to submit claims to third party payors; development of insurance appeals and denial reports, billing charge corrections, and analyzing reports related to documentation issues, coding patterns, physician productivity, reimbursement trends, etc.
•    Assist in analyzing third party payor reimbursement to ensure proper payment.
•    Assist in the development of and participate in orientation and continuing education sessions for physicians, residents and staff regarding billing procedures and changes in documentation requirements, coding and other pertinent reimbursement issues. This may involve presentations at faculty or staff meetings, individual counseling or written material.
•    Communicate with providers, payers, patients, internal departments, co-workers and coordinators to resolve issues.
•    Maintain extensive working knowledge and expertise based around payer regulations/policies, financial classifications and financial assistance programs.
•    Other duties as assigned. 

SUPERVISION RECEIVED:

The Referral Specialist reports to the HCCC Assistant Director, Outpatient Cancer Services.

SUPERVISION EXERCISED:

This role does not administratively nor functional supervise others.

University of Iowa Health Care—recognized as one of the best hospitals in the United States—is Iowa's only comprehensive academic medical center and a regional referral center. Each day more than 12,000 employees, students, and volunteers work together to provide safe, quality health care and excellent service for our patients. Simply stated, our mission is: Changing Medicine. Changing Lives.^®

Holden Comprehensive Cancer Center is Iowa’s only NCI-designated comprehensive cancer center. The NCI designation recognized our cancer center, and its research scientist, physicians, and other health care professionals, for their roles in advancing cancer research that impacts on our ability to prevent, detect and treat our patients with cancer. Not just a floor, or a building, or even confined to a single college. Holden Comprehensive Cancer Center coordinates all cancer-related research, education, and patient care by faculty from 41 departments and six colleges, as well as UI Health Care and UI Children’s Hospital.

Percent of Time: 100%

Work Schedule: Monday – Friday, Hours generally worked between 8:00am-5pm

Pay Grade: 2B

https://hr.uiowa.edu/pay/guide-pay-plans

Benefits Highlights:

•          Regular salaried position located in Iowa City, Iowa
•          Fringe benefit package including paid vacation; sick leave; health, dental, life and disability insurance options; and generous employer contributions into retirement plans
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