Revenue Cycle Representative (HMO Referral) - Patient Access Management (PAM) - Patient Financial Services

Position Summary:

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 HMO Referral 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 HMO Referral 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. 

This position is primarily a combination of remote and onsite (hybrid) work locations.  Remote work must be performed at an offsite location within the State of Iowa.  Training will be held either on ONSITE at the HSSB building or via zoom, with location and length of training 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.

University of Iowa Hospitals & Clinics—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.®

WE CARE Core Values:

• Welcoming:  We have an environment where everyone has a voice that is heard; that promotes the dignity of our patients, trainees, and employees; and allows all to thrive in their health, work, research, and education.
• Excellence:  We achieve and deliver our personal and collective best in the pursuit of quality and accessible health care, education, and research.
• Collaboration:  We collaborate with health care systems, providers, and communities across Iowa and the region as well as within our UI community. We believe teamwork – guided by compassion – is the best way to work.
• Accountability:  We behave ethically, act with fairness and integrity, take responsibility for our own actions, and respond when errors in behavior or judgment occur.
• Respect:  We create an inclusive environment where every individual feels safe, valued, and respected, supporting the well-being and success of all members of our community.
• Empowerment:  We commit to fair access to research, health care, and education for our community and opportunities for personal and professional growth for our staff and learners.

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 HMO referrals and 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 authorization denials and/or set-up peer to peer reviews.
• Collaborate with other departments to assist in obtaining authorizations in a cross-functional manner.
• Contact patients and insurance companies for payment acquisition, 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 referral/authorization 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/policies, financial classifications and financial assistance programs. 
• Build and maintain solid working relationships with clinical staff, referral sources, insurance companies, medical providers and public.

Classification Title: Revenue Cycle Representative (HMO Referral)

Department:  Patient Financial Services

Percent of Time: 100%

Pay Grade: 2B 

Location: Hospital Support Services Building (HSSB) located in Coralville, IA

This position is primarily a combination of remote and onsite (hybrid) work locations.  Remote work must be performed at an offsite location within the State of Iowa.  Training will be held either on ONSITE at the HSSB building or via zoom, with location and length of training 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.