Revenue Cycle Representative; VA Referrals - Patient Access Management; PAM - Patient Financi

Position Summary

University of Iowa Health Care Department Patient Financial Services seeks a Revenue Cycle Representative (RCR) for an entry‑level customer service and financial position within the health care industry. The PAM Division RCRs will provide exceptional customer service to external customers (patients, insurance contacts, etc.) as well as internal customers. The RCR will work in a high‑volume, fast‑paced, web‑based application environment and support a culture of Service Excellence by delivering high‑quality customer service and maintaining composure in difficult situations.

Compensation is based on the 2B pay grade.

This position is a hybrid of remote and onsite (remote work must be performed at an offsite location within the State of Iowa). Training will be held on‑site at the HSSB building or via Zoom. Remote eligibility will be evaluated after satisfactory training and work arrangements reviewed annually.

• Welcoming - We strive for an environment where everyone has a voice that is heard, that promotes the dignity of our patients, trainees, and employees, and allows all to thrive in their health, work, research, and education.
• Excellence - We aim to achieve and deliver our personal and collective best in the pursuit of quality and accessible healthcare, education, and research.
• Collaboration - We encourage collaboration with healthcare systems, providers, and communities across Iowa and the region, as well as within our UI community. We believe teamwork - guided by compassion - is the best way to work.
• Accountability - We behave ethically, act with fairness and integrity, take responsibility for our own actions, and respond when errors in behavior or judgment occur.
• Respect - We create an environment where every individual feels safe, valued, and respected, supporting the well‑being and success of all members of our community.
• Empowerment - We commit to fair access to research, health care, and education for our community and opportunities for personal and professional growth for our staff and learners.

• Review accounts, verify insurance coverage and initiate pre‑certifications, pre‑authorizations, referral forms and other requirements related to managed care; route to appropriate departments as needed.
• Assist in monitoring utilization services to assure cost effective use of medical resources through processing VA referrals and prior authorizations.
• Communicate with patients and/or referring physicians on non‑covered benefits or exam coverage issues.
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow‑up is performed.
• Ensure insurance carrier documentation requirements are met and authorization/referral documentation is scanned and recorded in the patient’s medical record.
• Appeal authorization denials and/or set‑up peer to peer reviews.
• Collaborate with other departments to assist in obtaining authorizations in a cross‑functional manner.
• Contact patients and insurance companies for payment acquisition, authorizations or to resolve patient account inquiries.
• Provide financial counseling to patients and families; determine if appropriate payment has been made by various entities; work with patients and insurance companies to obtain correct payments; appeal claim payments and/or denials.
• Collect demographic, insurance, and clinical information to ensure that all reimbursement requirements are met.
• Maintain an extensive working knowledge and expertise of insurance companies and billing authorization/referral requirements.
• Communicate with other referral/authorization specialists, patient account representatives and coders to continually monitor changes in the health insurance arena.
• Identify & report undesirable trends and reimbursement modeling errors or underlying causes of incorrect payment; review allowed variances from third party payers.
• Be expected to maintain a high‑level of accuracy to meet productivity and quality requirements.
• Identify trends and/or work processes for potential process improvements.
• Review and analyze report data to provide status updates to leadership.
• Communicate…