Title: Pharmacy Medical Billing Revenue Cycle Representative Location: Iowa City, Iowa, United States (Hybrid) Offsite 26003916 Job Description: Come Join Our Team! The Revenue Cycle Representative is a financial position in the healthcare industry necessary for hospital and pharmacy billing practices. This position requires strong computer skills, a high level of attention to detail, strong organizational skills, a general knowledge of hospital and medication billing practices, and excellent customer services skills. The Revenue Cycle Representative will work closely with both pharmacy and clinical staff within the hospital to support clinic administered and outpatient medically billed medications including infusions. Support includes, but is not limited to, benefits investigation, prior authorization completion, copay assistance support, and assistance with patient access. 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. POSITION RESPONSIBILITES: - Medication Access Support: - Assist patients and staff with benefits investigation and prior authorization completion for medication therapies billed to the medical benefit. - Communicate with patients, pharmacists and/ or providers to gather required information. - Verify patient insurance eligibility, benefits, coverage limitations, and authorization requirements. - Initiate and follow through for required prior authorizations, which may include pharmacy or medical authorizations. - Track authorization requests and follow up with payors to ensure timely determination. - Assist clinical pharmacy specialists or other providers with initiation of appeals when applicable. - Assist with copay/coinsurance assistance when applicable. - Monitor authorization expiration dates and obtain renewals for ongoing therapies. - Maintain accurate documentation of all authorizations within the electronic health record. - Communicate with patients, insurance companies, prior authorization and to assist with resolution of patient account inquiries. - Appeal/troubleshoot claim payments and/or denials using available resources. - Participate in process improvement and workflow optimization initiatives aimed at reducing authorization delays and improving patient access to care. - Assist the pharmacy coding and billing team with the resolution of claims issues. - 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 services in compliance with payor rules and regulations. - Adhere to compliance standards and policies to ensure UI Health Care receives full and accurate reimbursement for services in compliance with payor rules and regulations. - 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, identify, and report trends found during workflow or as assigned. - Compile information for audits as they arise from compliance and insurance/third party payors in a reportable manner. - Report discrepancies found during 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 medical billing practices for medications. - Complete and maintain compliance with all competencies and educational requirements. - Other duties as assigned 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. Experience Requirements: - 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. Desired Qualifications: - Experience working in a complex hospital system is highly desirable. - Medical medication management experience is highly desirable. - Medical billing experience is highly desirable. - Experience working in a collaborative team environment is desirable. - Pharmacy experience is desirable. - Knowledge of healthcare billing and prior authorization process, 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. 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 - Work Modality Options: Hybrid within Iowa Compensation - Pay Level: 2B

Role Description The Certified Coder I performs functions of coding diagnosis and procedures from outpatient center/clinic records utilizing International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. (Potential Remote) Typical Duties: - Assigns codes to diagnosis and procedures of outpatient records, including clinics, Urgent Care, and Emergency room, utilizing ICD and CPT codes in accordance with ICD Coding Guidelines, CPT Coding Guidelines, American Hospital Association (AHA) Coding Clinics, and the JPS Outpatient Coding Policy and Procedures. - Ensures codes are assigned accurately and sequenced correctly ensuring reimbursement is appropriate in accordance with government, insurance, and/or other payer regulations. - Identifies, researches, and corrects or routes accounts on the coding and billing edit work queues to meet coding guidelines and facilitate accurate billing. - Queries the provider when documentation is determined to be insufficient, conflicting, or ambiguous to elicit documentation reflecting the most accurate and specific conditions or procedures. - Maintains productivity and quality standards set forth in the District’s outpatient coding standards. - Utilizes online and hard copy coding reference materials. - Works closely with Outpatient Coding Supervisor and the health center/clinic medical and nursing staff regarding documentation and notification of charging issues. - Demonstrates evidence of professional growth by attending coding workshops, conferences, and/or seminars, maintaining required C.E. requirements (departmental and professional), and individual study and education regarding coding, reimbursement, and HIM competencies. - Performs other job-related duties as assigned. Qualifications - Required Education and Experience: High School Diploma, GED, or equivalent. - Preferred Education and Experience: 1 year outpatient coding experience. - Required Licensure/Certification/Specialized Training: At least one of the following registrations or certifications: - American Health Information Management Association (AHIMA): Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT), Certified Coding Specialist (CCS), or Certified Coding Administrator (CCA). - American Academy of Professional Coders (AAPC): Certified Professional Coder (CPC) or Certified Professional Coder-Hospital Outpatient (CPC-H). Company Description JPS Health Network is a $950 million, tax-supported healthcare system in North Texas. Licensed for 582 beds, the network features over 25 locations across Tarrant County, with John Peter Smith Hospital a Level I Trauma Center, Tarrant County's only psychiatric emergency center, and the largest hospital-based family medical residency program in the nation. The health network employs more than 7,200 people. Acclaim Multispecialty Group is the medical practice group featuring over 300 providers serving JPS Health Network. Specialties range from primary care to general surgery and trauma. The Acclaim Multispecialty Group formed around a common set of incentives and expectations supporting the operational, financial, and clinical performance outcomes of the network. Our goal is to provide high quality, compassionate clinical care for every patient, every time. When working here, you're surrounded by passion, diversity, and dedication. We look forward to meeting you!

Role Description The Virtual Benefits Coordinator is responsible for obtaining and documenting insurance eligibility and benefits for patients receiving infusion therapy. This position plays a critical role in ensuring accurate insurance verification, identifying coverage requirements, and supporting timely patient care by maintaining complete and up-to-date benefit information within the practice's systems. The Virtual Benefits Coordinator works primarily within the WeInfuse platform, prioritizing the verification queue, and collaborates closely with the infusion, billing, and clinical teams to ensure seamless communication regarding patient insurance coverage and authorization requirements. This position is co-managed by the Billing Manager and the Infusion Manager. Essential Duties and Responsibilities - Insurance Verification - Verify patient insurance eligibility and benefits for infusion services. - Contact commercial insurance companies, Medicare, Medicaid, and other payers to obtain accurate benefit information. - Utilize insurance carrier portals and payer websites to verify eligibility and benefits whenever available. - Determine coverage for both: - Infusion drug (J-code or applicable HCPCS code) - Drug administration (CPT administration code) - Identify and document payer requirements including: - Prior Authorization - Medical Necessity requirements - Pre-determination - Referral requirements - Coverage limitations - Deductibles, coinsurance, copays, and out-of-pocket responsibilities - Documentation - Maintain accurate and detailed documentation within the WeInfuse platform. - Complete all required verification fields manually and update each patient's verification status. - Prioritize and manage the WeInfuse Verification Queue to ensure timely completion of insurance verifications. - Document detailed notes regarding insurance conversations, reference numbers, representative names, and benefit information. - Enter and maintain insurance information within eClinicalWorks (eCW). - Update patient insurance information in eCW when new or changed coverage is identified. - Patient Communication - Contact patients when clarification regarding insurance coverage is needed. - Obtain updated insurance information from patients as necessary. - Communicate patient financial responsibility when directed by practice policies. - Maintain professional and courteous communication with patients at all times. - Team Collaboration - Communicate benefit verification findings promptly with: - Infusion Nurses - Billing Department - Billing Manager - Infusion Manager - Other Benefits Coordinators - Additional infusion staff as needed - Escalate insurance concerns or coverage issues to appropriate leadership. - Collaborate with the billing and infusion teams to resolve insurance-related issues that may impact scheduling or treatment. - System Management - Maintain proficiency in: - WeInfuse - eClinicalWorks (eCW) - Insurance carrier portals - Medicare and commercial payer websites - Ensure all documentation is accurate, complete, and entered in a timely manner. - Follow HIPAA guidelines and maintain patient confidentiality at all times. Qualifications - High school diploma or equivalent. - Minimum of one year of medical insurance verification, benefits coordination, or medical billing experience. - Experience verifying medical insurance benefits. - Strong understanding of medical terminology. - Experience working with electronic medical records (EMR). - Excellent written and verbal communication skills. - Strong organizational and time management skills. - Ability to prioritize multiple tasks in a fast-paced environment. - Attention to detail and high level of accuracy. Preferred Qualifications - Experience with infusion therapy benefit verification. - Experience using WeInfuse. - Experience using eClinicalWorks (eCW). - Knowledge of HCPCS (J-codes) and CPT administration codes. - Experience with prior authorizations and payer medical policies. Core Competencies - Insurance verification expertise - Critical thinking and problem-solving - Excellent documentation skills - Effective communication - Team collaboration - Time management - Attention to detail - Customer service - Confidentiality and professionalism Reporting Structure - Co-Managed By: - Billing Manager - Infusion Manager Work Environment - Remote/Virtual position. - Extensive computer and telephone use throughout the workday. - Regular interaction with insurance companies, patients, providers, and internal staff. - Must maintain a secure and HIPAA-compliant remote work environment. Performance Expectations - Timely completion of insurance verifications. - Accuracy of benefit documentation. - Effective prioritization of the WeInfuse verification queue. - Accurate maintenance of insurance information within eCW. - Clear and timely communication with infusion and billing teams. - Reduction in treatment delays related to insurance verification. - Compliance with practice policies, payer requirements, and HIPAA regulations.

Role Description The STARS Improvement Professional 2 develops, implements, and manages oversight of the company's Medicare/Medicaid Stars Program. Directs all Stars quality improvement programs and initiatives. The STARS Improvement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. - Develops programs designed to increase the plan quality. - Partners with leaders regarding implementation planning. - Reviews and communicates results of programs. - Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. - Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. - Follows established guidelines/procedures. General Duties/Responsibilities: - Review provider/member-specific UM and QI metrics and coach assigned providers (center/group less than 150 members) on gaps of care opportunities through virtual/telephone/email. - Provide resources and educational opportunities to providers and staff. - Promote practice-patients’ participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement. - Identify specific practice needs (e.g. use of most efficient interaction channel) to provide support. - Educate providers and staff about Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey. Qualifications - Bachelor's Degree in Business, Finance, Health Care or a related field. - 2+ years of clinical experience. - Prior Medicare/Medicaid experience. - Strong attention to detail and focus on process and quality. - Excellent communication skills. - Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint. Requirements - To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. - In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. - While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Benefits - Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being. - Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family. - Medical, dental and vision benefits. - 401(k) retirement savings plan. - Time off (including paid time off, company and personal holidays, paid parental and caregiver leave). - Short-term and long-term disability. - Life insurance and many other opportunities. Company Description Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.