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University of Rochester Referral Coordinator and Prior Authorization Specialist of New Patients and Referrals - 231161 in Rochester, New York

Referral Coordinator and Prior Authorization Specialist of New Patients and Referrals Job ID 231161

Location Medical Faculty Group Full/Part Time Full-Time Favorite Job Regular/Temporary Regular Opening

Full Time 40 hours Grade 009 Orthopaedic Appt Ctr


7:00 AM-7:00 PM


Job Summary:

With minimal direction and considerable latitude for independent judgment, oversees and directs Referral Coordinator/Prior Authorization Specialists. Able to assign and direct work to RC/PAS staff in addition to providing assistance to Access Center Manager for performance reviews. Responsible for training new employees and monitoring daily operations for quality assurance. Obtains prior authorizations for both standard and complex requests. Provides multiple and complex details to insurance carrier by anticipating their questions when reviewing and retrieving relevant information from the electronic medical record. Is accountable for planning, execution, appeals and efficient follow through on all aspects of the process which has direct, multifaceted impact (quality, financial, patient satisfaction, etc.) on patient scheduling, treatment, care and follow up. In addition, this role holds “expert-level” knowledge of the daily workflows and centralization efforts, including consistently and regularly identifying areas of improvement and establishing employee goals while demonstrating ICARE values.

Duties and Responsibilities

  • (25%) Staff Management

  • Coordinates daily assignments of RC/PAS to manage authorization processes and workqueue completion.

  • Provides assistance, guidance, and serves as a resource for complex and difficult authorizations and scheduling issues.

  • Participate in recruiting, hiring and promotion decisions. Completes performance evaluations.

  • Monitor staff performance and provides counsel to staff regarding any performance issues.

  • (20%) Training and Compliance

  • Collaborates and attends quarterly meetings with other RC/PAS Leads across the programs to establish best practice standards, implement those standards, and monitor adherence.

  • Provides training to RC/PAS on all aspects of referral work, including the following:

  • Electronic medical record system,

  • Patient record review,

  • Knowledge of provider sub-specialties,

  • Collection of additional information from provider to submit to insurance carrier when needed.

  • Notifies appropriate personnel in regards to RC/PAS access needed and coursework required to complete tasks.

  • Completes and presents training manual at the time of hire and reviews with new hires weekly to ensure understanding. Notifies manager of areas of concerns with training.

  • Demonstrates appropriate utilization of scheduling guidelines and verbiage to patients, providers, insurance carriers and PCP offices. Utilized as a resource for insurance and scheduling questions.

  • (20%) Referral Management

  • Develops, utilizes and modifies tracking mechanisms to ensure all renewals/approvals are obtained prior to patient arrival.

  • Determine best practices for referral completion based on the referral pathways.

  • Demonstrate understanding of referral pathways and applies that knowledge to support staff within the department.

  • Uses independent judgment to examine, research and assemble necessary patient information via the scheduling system and multiple areas of the electronic medical record.

  • (20%) Authorization Management

  • Prepares and provides multiple, complex details and facts to insurance carrier or worker’s compensation carrier to obtain prior authorizations for New Patient requests while utilizing various Referral Workqueues.

  • Communication and collaboration with insurance companies based on required authorizations and able to anticipate insurer’s various questions to prepare requests by applying prior insurer decisions and specialty/sub-specialty knowledge of the following:

  • General medical experience and terminology as well as specialty and sub specialty medical office experience

  • Extensive knowledge of International Classification of Diseases (ICD) and Current Procedure Technology (CPT)

  • Insurance policies

  • Shares new information regarding best practices

  • Nuances of various insurance carriers

  • Applies above listed knowledge and protocols to varying degrees based on how complexities of the situation deviate from the norm.

  • (15%) Customer Service Intervention

  • Proficient with phone etiquette and scheduling practices within the department of Orthopaedics.

  • Resolves obstacles presented by the primary care offices or insurance companies by applying knowledge and experience of previous authorization requests, denials and approvals. On behalf of the provider and the University, perseveres with the process to ensure as many applications are approved as possible without provider intervention.

    Minimum Qualifications:

    Associate’s degree in Medical, Secretarial, billing or related field, or a minimum of two 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