Pharmacy Medical Billing Revenue Cycle Representative (Hybrid) Offsite

Come Join Our Team! The Revenue Cycle Representative is a financial position in the healthcare industry necessary for hospital and pharmacy billing practices. This position requires strong computer skills, a high level of attention to detail, strong organizational skills, a general knowledge of hospital and medication billing practices, and excellent customer services skills. The Revenue Cycle Representative will work closely with both pharmacy and clinical staff within the hospital to support clinic administered and outpatient medically billed medications including infusions.  Support includes, but is not limited to, benefits investigation, prior authorization completion, copay assistance support, and assistance with patient access.

This position is eligible for a combination of remote work and in-person (hybrid) work within Iowa.  To be eligible for the hybrid remote work option, staff must be working in the position for a minimum of 6 months, must have successfully completed all training requirements, and must be meeting or exceeding expectations as assessed in a formal performance review or by leadership.  A work arrangement form will be required to be completed prior to the start of remote work.  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 RESPONSIBILITES: 

• Medication Access Support: 
  • Assist patients and staff with benefits investigation and prior authorization completion for medication therapies billed to the medical benefit.
    • Communicate with patients, pharmacists and/ or providers to gather required information.
    • Verify patient insurance eligibility, benefits, coverage limitations, and authorization requirements.
    • Initiate and follow through for required prior authorizations, which may include pharmacy or medical authorizations.
    • Track authorization requests and follow up with payors to ensure timely determination.
    • Assist clinical pharmacy specialists or other providers with initiation of appeals when applicable.
    • Assist with copay/coinsurance assistance when applicable.
    • Monitor authorization expiration dates and obtain renewals for ongoing therapies.
  • Maintain accurate documentation of all authorizations within the electronic health record.
  • Communicate with patients, insurance companies, prior authorization and to assist with resolution of patient account inquiries.
  • Appeal/troubleshoot claim payments and/or denials using available resources.
  • Participate in process improvement and workflow optimization initiatives aimed at reducing authorization delays and improving patient access to care.
  • Assist the pharmacy coding and billing team with the resolution of claims issues.
  • Provide accurate documentation of all activities as required by accrediting agencies, payers and/or administration.
  • Monitor reimbursement activity for medications to ensure UI Health Care receives full and accurate reimbursement for services in compliance with payor rules and regulations.
  • Adhere to compliance standards and policies to ensure UI Health Care receives full and accurate reimbursement for services in compliance with payor rules and regulations.
  • Provide the highest customer servic