Referral & Prior Auth Lead

Rochester, NY

Responsibilities

Summary:

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.

Responsibilities:

  • 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.

  • Provides training to Prior Authorization and Referral Coordinator Associates and Specialists 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.

  • Performs quality assurance monitoring for activities in area of immediate responsibility and other areas that affect it utilizing specific criteria. Measures quality, quantity and timeliness of tasks performed. Prepares related logs and management reports.

  • Implements and monitors departmental/office specific procedures, to work in conjunction with enterprise established processes, for enhancing levels of service and quality. Develops departmental/office guidelines for prioritizing and assigning work activities, evaluates effectiveness and modifies processes as necessary.

  • Collaborates with other Prior Authorization and Referral Coordinator Leads across programs to establish best practice standards. Disseminates those standards and implements and monitors the adherence to those standards.

  • Coordinates daily assignments of Prior Authorization and Referral Coordinator Associates and Specialists.

  • Participates in recruiting, hiring and promotion decisions. Completes performance evaluations. Monitors staff performance and counsel’s staff regarding performance issues. Manages and approves staff requests for time off and overtime. Adjusts schedule and duties as necessary.

  • Acts as resource for information. Attends educational programs for department at the direction of supervisor. Educates other staff on materials.

Other duties as assigned

Qualifications:

Required Experience:

  • High School Diploma required

  • 2 years of relevant experience, including 1 year of demonstrated leadership required

  • or equivalent combination of education and experience required.

Preferred Experience:

  • Medical terminology

  • Surgical/appointment scheduling software, such as Flowcast

  • Electronic medical records

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $19.00 - $24.70 Hourly

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.

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Location: Medical Faculty Group
Full/Part Time: Full-Time
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