Revenue Cycle Representative (Hybrid) Offsite

The Pharmacy Prior Authorization Revenue Cycle Representative works to support patients in obtaining insurance coverage for outpatient pharmacy medications. The position will primarily focus on performing benefits investigations, providing prior authorization support, and researching patient financial assistance options such as copay assistance and grant programs. This position requires strong computer skills, a high level of attention to detail, strong organizational skills, a general knowledge of hospital and prescription billing practices, and excellent customer services skills. The Pharmacy Prior Authorization Revenue Cycle Representative will work closely with other staff within the health system to assist patients in gaining timely access to medications.

• 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.
    • Assist clinical pharmacy specialists or other providers with initiation of appeals when applicable.
    • Assist 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.
  • Monitor reimbursement activity for medications to ensure UI Health Care receives full and accurate reimbursement for pharmacy services in compliance with payor rules and regulations.
  • Monitor compliance standards and policies to ensure UI Health Care receives full and accurate reimbursement for services in compliance with payor rules and regulations.
  • Assist with the resolution of patient shipment issues in a timely manner.
  • Provide refill management calls and follow up to Specialty Pharmacy patients when assigned.
  • Assist Specialty Pharmacy and external pharmacy staff with the resolution of claims issues.
  • 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 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.

• Other duties as assigned

• 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.

• 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.

• 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.

• Resume
• Cover Letter