Referral & Prior Auth Rep IV

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address):

220 Hutchison Rd, Rochester, New York, United States of America, 14620

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

500188 Med Specialties AC-3 Clerical

Work Shift:

Range:

UR URCB 205 H

Compensation Range:

$20.31 - $27.42

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Responsibilities:

Oversees and provides direction to Prior Authorization and Referral Coordinator Associates and Specialists. Trains new employees. Resolves problems and issues. Monitors quality assurance of daily operations. Provides coaching and training support.

Schedule 8 AM-4:30 PM Responsibilities GENERAL PURPOSE: Serves as a critical member of the Department of Medicine flex team to provide support to areas in need and provide direction to lower level team members and serve as the point of contact for questions and problem solving. With minimal direction from the flex pool leader and assigned division leader(s), manages referral work queues ensuring appropriate triaging and scheduling of patient visits, procedures and testing, in alignment with department and enterprise standards. Obtains prior authorizations as needed and assists the team with other assistance as needed. May assist in training new staff members to the flex team. RESPONSIBILITIES: - Manages referral queues for assigned area(s), ensuring appropriate triaging and scheduling within department and enterprise policies and standards. Serves as point of contact to answer questions and solve problems for difficult and unusual authorizations and referrals. Assists in problem identification, quantification and resolution. Serves as liaison, appointment coordinator, and patient advocate between the referring office, specialists and patient to assist in the coordination of scheduled visits and procedures incorporating all incoming referrals to the department using Epic Referral work queues - Works closely with Department and Division leadership teams to identify opportunities to bring workflows into alignment with ambulatory and departmental standards. Keeps abreast of new policies and identifies impacts on divisional workflows. Effectively communicates and collaborates with staff and leaders in up to 15 Divisions of the Department of Medicine. - Performs quality assurance monitoring for referral queue by reviewing and analyzing referral volume & workqueue management reports. Measures quality, quantity and timeliness of tasks performed. Conducts data analyses to track patient compliance with specialty services, consistently monitors the work queues and communicates with referring and referred to departments to reconcile any discrepancies and/or answer any questions. Escalates case management when medical assessment is needed. - Manage and oversee the prior authorization process for procedures, specialty office visits, VA (Veterans Affairs) referrals, and outside radiology appointments. Verify patient insurance information as it relates to obtaining PA's. - Referral clean up- Assist with referral work queue and referral clean up by reviewing referrals in queues )1 month and determining referral status (scheduled, incomplete, patient declined, etc.) - Provides training to other staff on all aspects of referral work, including electronic medical system support, patient record review, appointment and/or ancillary test scheduling, procedural scheduling, knowledge of provider sub-specialties and collection of additional information from provider or electronic medical system to submit to insurance carrier when needed. - Assists Divisions with ancillary test scheduling and coordination and reviewing orders in Epic baskets. Other duties as assigned QUALIFICATIONS: - High School Diploma and a minimum of two years of relevant experience required, or an equivalent combination of education and experience required. - Medical terminology, surgical/appointment scheduling software, such as Cadence, and electronic medical records preferred. - Demonstrated ability to word process documents and ent