Clinic Services Specialist - Utilization Management
The Utilization Management Department at the University of Iowa is seeking a Precert Services Specialist to perform benefit authorizations and inquiries, secure prior authorization for treatment and other visits. The position may also support inquiries for financial navigation and work with the care team and other departments regarding Peer to peer calls and reconsideration requests. The Precert Services Specialist works in a fast-paced, high volume environment multitasking between telecommunication and web-based applications delivery a high level of customer service in a timely manner.
Duties Include:
• Ensure all patient services are financially secured by completing insurance notification within 24 hours of services rendered.
• Contact insurance companies, care teams and other groups within the utilization review department to ensure pre-certification is complete and patient account inquiries are resolved.
• Analyze and verify patient demographic, insurance eligibility and financial information/responsibility for accurate claim submission and reimbursement.
• Work with patients and insurance companies to obtain correct precerts; report on denials.
• Identify and report undesirable trends and reimbursement modeling errors or underlying causes of incorrect payment; review allowed variances from third party payers.
• 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.
• Build and maintain solid working relationships with clinical staff, referral sources, insurance companies, medical providers and public.
• Review CPT, HCPCS and/or ICD-10 codes for provided services. Review and assess medical record documentation to support codes and/or identify missed professional and technical billing opportunities.
• Communicate at the direction of the Nursing staff in UM with physicians (resident and staff) and other professionals who bill third party payors to resolve situations where the recommended-billed service is not supported in the medical record and/or not consistent with CPT, HCPCS and/or ICD10 guidelines and third-party payors’ documentation requirements.
• Review at the direction of the Nursing staff in UM and apply third party payor (Medicare, Medicaid, Wellmark, etc) billing regulations and compliance program standards. Assist in the design and development of systems for the capture of charge data and reimbursement data with regard to medical services.
• Investigate and obtain required authorizations or referrals for services when necessary, including but not limited to, Hospital admissions.
• Communicate with Social Service at the direction of the Nursing Staff in UM regarding coverage change and or laps in coverage.
• Assist in the development of and participate in orientation and continuing education sessions for physicians, residents and staff regarding billing procedures and changes in documentation requirements, coding and other pertinent reimbursement issues. This may involve presentations at faculty or staff meetings, individual counseling or written material.
• Communicate with providers, payers, patients, internal departments, co-workers and coordinators to resolve issues.
• Maintain extensive working knowledge and expertise based around payer regulations/policies, financial classifications and financial assistance programs.
• Other duties as assigned.
The information contained herein is not intended to be an exhaustive list of all responsibilities required of individuals performing this job.
Percent of Time: 100%
Schedule: Monday through Friday, 7:30 AM to 4:00 PM / Varied
Benefits Highlights:
• Regular salaried position located in Iowa City, Iowa
• Fringe benefit package including paid vacation; sick leave; health, dental, life and disability insurance options; and generous employer contributions into retirement plans
• For more information about Why Iowa?, click here
REQUIRED QUALIFICATIONS:
• Bachelor’s Degree or an equivalent combination of education and experience is required.
• Excellent written, verbal and interpersonal communication skills.
• Must be proficient in computer software applications.
• Related customer service experience (minimum 6 months) in a health care or research related environment.
• Demonstrated ability to handle complex and ambiguous situations with minimal supervision.
• Self-motivated with initiative to seek out additional responsibilities, tasks and projects.
• Ability to maintain extreme confidentiality.
HIGHLY DESIRABLE QUALIFICATIONS:
• Completion of diploma or degree program in Health Information Management.
• Knowledge, understanding and experience with CMS regulations or industry standards.
• Experience working in EPIC.
• Prior experience working with insurance companies and patient coverages.
• Demonstrated working knowledge and experience (minimum 6 months) of ICD-9 and ICD-10 coding.
DESIRABLE QUALIFICATIONS:
• Experience maintaining professionalism while handling difficult situations with callers/customers.
• Knowledge of anatomy and physiology.
• Knowledge of hematology/oncology medical terminology.
• Knowledge of University of Iowa policies, procedures and regulations
Application Process: In order to be considered, applicants must upload cover letter and resume (under submission relevant materials) that clearly address how they meet the listed required and desired qualifications of this position.
• Job openings are posted for a minimum of 14 calendar days.
• Successful candidates will be subject to a criminal background check.
• For additional questions please contact, seton-vinsand@uiowa.edu.
Equal Opportunity/Affirmative Action employer
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, national origin, age, sex, pregnancy, sexual orientation, gender identity, genetic information, religion, associational preference, status as a qualified individual with a disability, or status as a protected veteran. The University also affirms its commitment to providing equal opportunities and equal access to University facilities. Women and Minorities are encouraged to apply for all employment vacancies. For additional information on nondiscrimination policies, contact the Coordinator of Title IX and Section 504, and the ADA in The Office of Equal Opportunity and Diversity, 319/335-0705 (voice) or 319/335-0697 (text), The University of Iowa, 202 Jessup Hall, Iowa City, Iowa, 52242-1316.
Persons with disabilities may contact University Human Resources/Faculty and Staff Disability Services, (319) 335-2660 or fsds@uiowa.edu, to inquire or discuss accommodation needs
