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University of Rochester Prior Authorization Spec - 227924 in Rochester, New York

Prior Authorization Spec Job ID 227924

Location Strong Memorial Hospital Full/Part Time Full-Time Favorite Job Regular/Temporary Regular Opening

Full Time 40 hours Grade 009 Women's Health Practice

Responsibilities

Position Summary:

With general direction and latitude for initiative and judgment performs routine and non- routine administrative duties to monitor and process department's referrals. Is accountable for completing all referrals in a manner compliant with University standards. The majority of referrals processed are those received by the department but also processes those prescribed by the department's providers.

Responsibilities:

In processing referrals for receiving providers as well as prescribing providers, prioritizes referrals by following and applying standard policies, procedures and practices. Employs multiple tracking mechanisms to ensure that referral approvals and appointments are obtained in a timely way so that patients are always cleared for their appointment prior to their arrival. Enters progress notes and other pertinent information into the electronic medical record based on application of practices and procedures.

Specific blend of referral duties may vary and are related to the department structure and business needs:

Receiving Department General Queue 40%

  • Provides training to all new referral scheduling staff.

  • Reviews referrals to determine what clinic in OBGYN should receive the referral. Send encounter to appropriate scheduler or make assignments so clinic is aware of referral.

  • Monitor all work queues to ensure referrals are processed in a timely manner. Phone calls, and letters done timely.

  • Works with all departments to ensure that urgent patients are seen if the referral department needs to be changed.

  • COVID-19 – Send referral to departmental provider to review and prioritize referral.

  • Reviews referrals to determine if insurance authorization has been obtained. If no authorization, works directly with that Prior Authorization team to obtain one.

  • Identifies, by applying knowledge of provider sub-specialties, the appropriate provider with whom to make an appointment.

  • Conveys instructions to patients for appointment by applying the appropriate protocol. Enters scheduled appointment information into electronic medical record for referring provider office to view.

  • Enter outside messages and referrals. Includes contacting offices or clarification or if the referral is inappropriate.

    Receiving Department Specialty Handling 20%

  • Review referral for appropriateness for referred to correct department scheduler. Monitor for x2 attempts and send unable to contact letter for specified departments

    • Redck Pelvic health
  • SCLN Gyn

  • MIG/Pain-30 day

  • WHP Pain-30day

  • Count and track number of referrals per scheduler/ department each day. Ensure referrals are being worked timely. Contact scheduler to assist if numbers not changing and appear to not being worked. Ensure referrals do not reach a high number and patients are contacted in a timely manner.

  • Provide additional assistance with specialty departments. Colposcopy- send referral to be reviewed by nurse before assigning to colposcopy scheduler. WHP Pelvic pain- ensure referral appropriate per Pain guidelines. Help PSS with questionnaire monitoring and redirecting of patients as needed.

  • Monitor Approved Prior Authorizations and attach to appointments. Ensure they are closed once expired or if the procedure is no longer needed.

  • Monitor referrals per department and send out updated reports every Friday.

    Referring/Prescribing Provider 40%

  • Assembles, from multiple tabs within the electronic medical record, the necessary details to identify what referral is needed.

  • Determines if preliminary testing (i.e. Imaging) is needed based on office practices and procedures and is responsible for explaining to patient, assisting with scheduling and for completeness prior to office visit.

  • Anticipates, gathers and sends information to insurance carrier and/or provider needed for obtaining referral or prior authorization for required preliminary testing.

  • Completes the referral request in the electronic medical record system once the patient has been seen by entering a new status as closed.

    Qualifications:

    Associate's degree in Medical, Secretarial or related field and a minimum of three years of relevant experience required; or an equivalent combination of education and experience. Medical Terminology, experiences with surgical/appointment scheduling software, and electronic medical records, preferred. Demonstrated customer relations skills.

    How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

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