Pharmacy Prior Authorization Revenue Cycle Representative
2 months ago
Duties to include:
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, pharmacists and/ or providers to gather relevant demographic information.
- 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.
- 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.
- 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.).
- 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.
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.
- 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.
Position and Application details:
In order to be considered for an interview, applicants must upload the following documents and mark them as a "Relevant File" to the submission:
- Resume
- Cover Letter
Successful candidates will be required to self-disclose any conviction history and will be subject to a criminal background check and credential/education verification. Up to 5 professional references will be requested at a later step in the recruitment process.
For additional questions, please contact Penni Berger at penelope-berger@uiowa.edu
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
- Pay Level: 2B
- Organization: Healthcare
- Contact Name: Penni Berger
- Contact Email: penni-berger@uiowa.edu
The University of Iowa is an equal opportunity/affirmative action employer. All qualified applicants are encouraged to apply and will receive consideration for employment free from discrimination on the basis of race, creed, color, religion, national origin, age, sex, pregnancy (including childbirth and related conditions), disability, genetic information, status as a U.S. veteran, service in the U.S. military, sexual orientation, gender identity, or associational preferences.
-
Iowa City, United States The University Of Iowa Full timeThe Department of Pharmaceutical Care is seeking a full-time Prior Authorization Revenue Cycle Representative to join our team. 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,...
-
Iowa City, United States The University Of Iowa Full timeThe Department of Pharmaceutical Care is seeking a full-time Prior Authorization Revenue Cycle Representative to join our team. 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,...
-
Revenue Cycle Coordinator
3 weeks ago
Iowa City, Iowa, United States The University Of Iowa Full timeJob SummaryThe University of Iowa is seeking a highly skilled Revenue Cycle Coordinator to join our team in Johnston, IA. As a key member of our financial services team, you will play a critical role in ensuring the smooth operation of our revenue cycle processes.Key ResponsibilitiesProvide financial counseling to patients and families to ensure they are...
-
Revenue Cycle Coordinator
2 weeks ago
Iowa City, Iowa, United States The University Of Iowa Full timeJob SummaryThe University of Iowa is seeking a highly skilled Revenue Cycle Coordinator to join our team in Johnston, IA. As a key member of our financial services team, you will play a critical role in ensuring the efficient and accurate processing of patient financial information.Key ResponsibilitiesProvide financial counseling to patients and families to...
-
Prior Authorization Specialist
2 weeks ago
Oklahoma City, Oklahoma, United States BrightSpring Health Services Full timeAbout the RoleWe are seeking a skilled Prior Authorization Specialist to join our team at Amerita. As a key member of our team, you will be responsible for ensuring the proper initiation, clinical review, submission, and follow-up of prior authorizations for medication and supply. This role requires a strong understanding of pharmacy benefits and prior...
-
Prior Authorization Specialist
2 weeks ago
Oklahoma City, Oklahoma, United States BrightSpring Health Services Full timeAbout the RoleWe are seeking a skilled Prior Authorization Specialist to join our team at Amerita. As a Prior Authorization Specialist, you will play a critical role in ensuring that patients receive the necessary medications and supplies in a timely manner.ResponsibilitiesInitiate, process, and oversee the clinical review of prior authorization requests for...
-
Prior Authorization Specialist
2 weeks ago
Oklahoma City, Oklahoma, United States BrightSpring Health Services Full timePrior Authorization Specialist Job DescriptionAt Amerita, we are seeking a skilled Prior Authorization Specialist to join our team. As a Prior Authorization Specialist, you will play a critical role in ensuring that patients receive the necessary medication and supplies in a timely manner.Key Responsibilities:Initiate, process, and oversee the clinical...
-
Iowa City, United States University of Iowa Full timeThe Billing Specialist, Revenue Cycle Representative is responsible for managing the billing process for the Scanlan Center for School Mental Health Clinic (75%) and Belin Blank Center Clinic (25%), ensuring compliance with insurance requirements, and providing financial counseling to clients. The billing specialist works closely with the clinic supervisors,...
-
Revenue Cycle Manager Home Infusion
2 weeks ago
New York City, United States Gables Search Full timeRevenue Cycle Manager Home Infusion Responsibilities: • Revenue Cycle for Home Infusion and Specialty Pharmacy• Billing and Coding• Claims management• Claims denials• Collections and Accounts Receivable• Revenue reporting Requirements:• 3 years’ experience Revenue Cycle Management in Home Infusion and Specialty Pharmacy• Bachelor’s degree...
-
Prior Authorization Specialist
1 month ago
new york city, United States Tandym Group Full timeA Health Care Start-up is seeking a Prior Authorization Specialist based in NYC.Worksite Setting: On-site office, but may switch to remote/hybrid down the road.Worksite location(s): SoHo NYCSchedule: Full time day flexible, minimum 20 hrs/week (weekdays only)JOB Description:Start Date: ImmediateKey Responsibilities* Complete prior authorization requests...
-
Prior Authorization Specialist
1 month ago
new york city, United States Tandym Group Full timeA Health Care Start-up is seeking a Prior Authorization Specialist based in NYC.Worksite Setting: On-site office, but may switch to remote/hybrid down the road.Worksite location(s): SoHo NYCSchedule: Full time day flexible, minimum 20 hrs/week (weekdays only)JOB Description:Start Date: ImmediateKey Responsibilities* Complete prior authorization requests...
-
Authorization Representative
2 days ago
Carson City, Nevada, United States CVS Health Full timeJob Title: Authorization RepresentativeCVS Health is seeking a highly skilled Authorization Representative to join our national team. As an Authorization Representative, you will play a critical role in securing authorizations for our patients, ensuring timely prescription orders, and delivering exceptional customer service to our referrals, insurance...
-
Patient Access Representative II
2 weeks ago
Valley City, North Dakota, United States Conifer Revenue Cycle Solutions Full timeJob SummaryWe are seeking a highly skilled Patient Access Representative II to join our team at Conifer Revenue Cycle Solutions. As a key member of our healthcare team, you will be responsible for providing exceptional patient care and ensuring seamless registration and scheduling processes.Key Responsibilities:Perform patient registration, scheduling, and...
-
Revenue Cycle Quality Training Specialist
2 days ago
Kansas City, Missouri, United States University Health Full timeJob SummaryThis position is responsible for the development, design, administration, and management of training programs throughout the organization. The ideal candidate will have a strong background in healthcare and revenue cycle experience, with excellent interpersonal, writing, and presentation skills.Key ResponsibilitiesDevelop and implement training...
-
Pharmacy Technician
2 weeks ago
Iowa City, Iowa, United States NuCara Pharmacy Full timePharmacy Technician Job DescriptionNuCara LTC is a leading long-term care pharmacy in Iowa City, IA, specializing in medication packaging and distribution to nursing homes, assisted living facilities, and group homes in Eastern Iowa.We are seeking a full-time certified pharmacy technician to join our healthcare team. As a pharmacy technician, you will work...
-
Clinical Pharmacist
3 weeks ago
Oklahoma City, Oklahoma, United States National Health Care Solutions Full time{"title": "Clinical Pharmacist - Prior Authorization Specialist", "content": "Job SummaryWe are seeking a highly skilled Clinical Pharmacist to join our team as a Prior Authorization Specialist. In this role, you will be responsible for reviewing and managing prior authorization requests for medications, ensuring that our clients receive the best possible...
-
Clinical Pharmacist
4 weeks ago
Oklahoma City, Oklahoma, United States National Health Care Solutions Full timeAbout the RoleWe are seeking a highly skilled Clinical Pharmacist to join our team at National Health Care Solutions. As a Clinical Pharmacist - Prior Authorization Specialist, you will play a critical role in ensuring the accuracy and efficiency of our prior authorization process.Key ResponsibilitiesDocument Review and Management: Review, create, and...
-
Revenue Cycle Quality Training Analyst
3 months ago
Kansas City, United States University Health Full timeIf you are a current University Health or University Health Physicians employee and wish to be considered, you must apply via the internal career site. Please log into to search for positions and apply. Revenue Cycle Quality Training Analyst101 Truman Medical Center Job Location Truman Support Center, UH Lakewood Medical Center, University Health...
-
Revenue Cycle Quality Training Specialist
3 weeks ago
Kansas City, Missouri, United States University Health Full timeAbout University HealthUniversity Health is a 547-bed, not-for-profit health system serving as the primary teaching institution for the UMKC Schools of Medicine, Nursing, Dentistry, and Pharmacy. We deliver high-quality medical care with compassion, empathy, and unparalleled dedication to service.Our MissionWe strive to provide exceptional patient care,...
-
Director Revenue Cycle
2 months ago
Garden City, United States OCLI Vision Full timeABOUT USSpectrum Vision Partners (“SVP”) and OCLI Vision (“OCLI”) work together to provide world class eye care to our patients to improve lives. SVP, the management services team, supports OCLI vision, one of the largest multi-specialty ophthalmology networks in the U.S. Our unique model and collaborative culture differentiate us in the marketplace...