University of Rochester Referral and Prior Auth Spec - 223788 in Rochester, New York
Referral and Prior Auth Spec
Strong Memorial Hospital
Full Time 40 hours Grade 009 Medicine SMH Gastrointestinal
Under general supervision of the Administrator for the GI clerical team, the Referral and Prior Authorization Specialist’s primary function is to facilitate the entire process of scheduling patients referred to URMC for outpatient GI Care. Facilitation of appointment scheduling includes ensuring appropriate authorization is obtained prior to receiving care. As an integral member of the GI health care team, the Referral and Prior Authorization Specialist will collaborate with referral coordinators, Physician Support Specialists, medical providers, and other patient care support staff to ensure that internal and external referrals are responded to in a timely fashion and that authorizations are in place at the time of the appointment.
Specific Job Responsibilities:
- Review incoming referrals sent to GI through the eRecord system. Respond to urgent referrals immediately; if needed route them to nurse for evaluation and scheduling timeframe recommendations. Ensure accurate registration is completed, updating patient demographic information if needed. Organize and prioritize workload based on acuity. Contact healthcare specialists if patient’s referral is incomplete to ensure all records required to schedule an appointment is on file. Requests necessary reports, records and tests for referral completion. Process incoming faxes, review and route to HIM so they can be uploaded into the patients’ charts. Communicate with PSS staff daily to work through any questions that arise in scheduling patients for their appointments and clarify provider requirements. Close out referrals in eRecord once patients have been scheduled for their appointments.
- Utilize tools in Cadence to find available procedure and office visit appointments for patients. Call patients to review appointment details and mail prep instructions as needed. Follow up with provider offices and patients to keep them updated on status of appointment requests. Serve as a resource to new patients who have questions about any details of their appointments. Schedule procedure appointments directly on behalf of patients once triage of patient’s health status has been completed. Call patients to remind them of upcoming appointments. Look at future schedules to ensure that utilization is maximized and proactively work to fill any openings that result from cancelled appointments or unanticipated changes in schedules. Use Cadence and other Epic tools to run reports to appropriately book appointments based on patient’s residence and geographic location of our sites.
- Obtain authorization for GI procedure appointments as required by our patient’s payors. Ensures required authorizations are in place prior to date of patient appointments to mitigate loss of revenue or reimbursement. Utilizes electronic authorization submission systems such as Evicore to expedite approval of tests and procedures requested by our providers, including imaging. When necessary may assist with coordinating GI provider peer to peer reviews to appeal services that have been denied. Familiarizes themselves with CPT and ICD 10 codes that are specific to gastroenterology and hepatology in order to facilitate efficient processing of prior authorizations. Anticipates when an insurance company may deny an authorization request based on previous experience and knowledge of payor expectations. Establishes a strong working knowledge of Veterans Administration prior authorization requirements and a minimal understanding of worker’s compensation claims as it applies to GI patients who are being seen under those circumstances.
Process outgoing referrals:
Coordinates with external specialists’ offices to ensure that patients who our providers refer for healthcare services that supplements and/or advances their GI care is completed. Manages any ancillary testing and obtains outside records as needed.
Education and Experience Requirements:
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, experience with surgical/appointment scheduling software and electronic medical records such as eRecord is preferred. Demonstrated customer relation skills.
How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled