The Pharmacy Prior Authorization Revenue Cycle Representative supports patients in obtaining insurance coverage for outpatient pharmacy medications, focusing on benefits investigations, prior authorization support, and researching patient financial assistance options such as copay assistance and grant programs. Duties include assisting patients and staff with benefits investigation and enrollment into pharmacy services, communicating with patients, pharmacists, and providers to gather information, initiating and following through with prior authorizations, assisting with appeals, copay/coinsurance assistance, claim payment troubleshooting, documentation for accrediting agencies and payors, monitoring reimbursements for pharmacy services ensuring compliance with payor rules, resolving patient shipment issues, refill management calls to Specialty Pharmacy patients, and supporting pharmacy billing operations.
The position requires strong computer skills, attention to detail, organizational skills, knowledge of hospital and prescription billing practices, and excellent customer service skills. Communication with providers, payors, patients, and team members to resolve revenue cycle issues is essential. This role also involves reporting and analysis to identify trends and discrepancies, participation in policy and technology evaluations, and contributing to orientation and training of pharmacy personnel.
The position offers hybrid remote work for Iowa residents after meeting criteria including minimum tenure, successful training completion, and performance standards. Work arrangements are reviewed annually to ensure policy compliance.
Education requirements include completion of a Bachelor’s degree or equivalent experience, with successful completion of the pharmacy technician certification exam within 12 months of employment. Previous customer service experience and proficiency with software applications are required, along with familiarity with medical terminology. Desired qualifications include experience in a hospital system, collaborative team environments, pharmacy experience, knowledge of healthcare billing and insurance programs, experience with technology platforms (e.g., Epic, GE), and understanding of HIPAA.
- 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 employment.
- Previous experience in customer service.
- Experience and proficiency with computer software applications (e.g., Microsoft Office Suite).
- Strong attention to detail and ability to gather and analyze data.
- Self-motivated with initiative to take additional responsibilities and suggest workflow improvements.
- Effective verbal and written communication skills, active listening skills, and professionalism.
- Problem-solving abilities and resourcefulness.
- Familiarity with medical terminology.
Desired:
- Experience working in a complex hospital system.
- Experience in a collaborative team environment.
- Pharmacy experience.
- Knowledge of healthcare billing and insurance or assistance programs.
- Experience with systems such as Epic, GE.
- Knowledge of HIPAA regulations.
- Ability to work effectively with diverse individuals.
- Hybrid remote work arrangement within Iowa after meeting eligibility requirements.
- Access to UI Health Care services and employee well-being resources.
- Generous retirement benefits.
- Exceptional health insurance plans including dental and vision.
- University-paid life insurance and long-term disability.
- Paid vacation, holidays, and sick leave.
- Mental health and wellness support.
- Opportunities for professional growth and continuous learning.
Location
Iowa, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 week ago