Revenue Cycle Representative (Hybrid) Offsite

Patient Revenue Management

• Assist patients and staff with benefits investigation and enrollment of patients into pharmacy services (i.e. specialty pharmacy).
• Communicate with patients, pharmacists and/or providers to gather relevant demographic information.
• Initiate and follow through for required prior authorizations, which may include pharmacy or medical authorizations.
• Aid clinical pharmacy specialists or other providers with initiation of appeals when applicable.
• Aid with copay/coinsurance assistance when applicable.
• Communicate with patients, insurance companies, credit/collections for payment acquisition, pre-authorization, and to resolve patient account inquiries.
• Appeal/troubleshoot claim payments and/or denials using available resources.
• Provide accurate documentation of all activities as required by accrediting agencies, payers, and/or administration.
• Maintain reimbursement activity for medications to ensure UI Health Care receives full and accurate reimbursement for pharmacy services in compliance with payor rules and regulations.
• Maintain compliance standards and policies to ensure UI Health Care receives full and accurate reimbursement for services in compliance with payor rules and regulations.
• Resolve pharmacy billing discrepancies and identify possible trends.
• Identify areas to improve the billing process.
• Identify areas to improve the benefits investigation and prior authorization process.
• Participate in standard pharmacy operations as the need arises.

Operations and Performance Standards

• Utilize tools and processes to maximize the efficiency of the revenue cycle.
• Resolve pharmacy billing discrepancies and identify possible trends.
• Identify areas to improve the billing process.
• Identify areas to improve the benefits investigation and prior authorization process.
• Comply with established cash handling policies and procedures of the institution and department.
• 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.

Reporting

• Analyze and prepare routine reports to identify trends and aid in making financial decisions.
• Compile information for audits as they arise from compliance and insurance/third party payors in a reportable manner.
• Report discrepancies found during report analysis.
• Document activities required by accrediting agencies, payors, and/or administration (i.e. workload statistics, phone statistics, etc.).

Communication/Training

• Communicate with providers, payors, patients, co-workers, supervisors, and departments to resolve revenue cycle issues.
• Understand the importance of effective business communication and maintaining professionalism in difficult situations.
• Participate in orientation of pharmacy technicians, pharmacists, pharmacy residents, and others within the department on pharmacy billing practices.
• Complete and maintain compliance with all competencies and educational requirements.

Education Requirements

• Completion of a Bachelor’s degree or equivalent combination of education and experience.

Experience Requirements

• Previous experience in customer service.
• Proficiency with computer software applications (i.e. Microsoft Office Suite – Word, Excel, Outlook, PowerPoint) or comparable programs.
• 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.
• Educated and skilled in effective verbal and written communication skills, active listening skills, and the ability to maintain professionalism while handling difficult situations.
• Demonstrated effective problem solving abilities and meets challenges with resourcefulness.
• Familiarity with medical terminology.

Desired Qualifications

• Experience working in a complex hospital system is highly desirable.
• Experience working in a collaborative team environment is desirable.
• Pharmacy experience is desirable.
• Knowledge of healthcare billing, experience working with insurance and/or federal and state assistance programs 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.
• Professional experience working effectively with individuals from a variety of backgrounds and perspectives.