Pharmacy Medical Billing Revenue Cycle Representative

Title: Pharmacy Medical Billing Revenue Cycle Representative

Location: Iowa City, Iowa, United States

(Hybrid) Offsite

26003916

Job Description:

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 service experience for patients and providers.

• 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, identify, and report trends found during workflow or as assigned.

• Compile information for audits as they arise from compliance and insurance/third party payors in a reportable manner.

• Report discrepancies found during 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 medical billing practices for medications.

• Complete and maintain compliance with all competencies and educational requirements.

• Other duties as assigned

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:

• Previous experience in customer service

• Experience and 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.

• Effective verbal and written communication skills, active listening skills and the ability to maintain professionalism while handling difficult situations.

• Demonstrate 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.

• Medical medication management experience is highly desirable.

• Medical billing experience is highly desirable.

• Experience working in a collaborative team environment is desirable.

• Pharmacy experience is desirable.

• Knowledge of healthcare billing and prior authorization process, 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.

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.

Additional Information

• Classification Title: Revenue Cycle Representative
• Appointment Type: Professional and Scientific
• Schedule: Full-time
• Work Modality Options: Hybrid within Iowa

Compensation

• Pay Level: 2B