Referral & Prior Auth

Rochester, NY


The Financial Counselors assess all aspects of patient financial account management for all urgent, emergent, and preadmission visits with a Surgery Admit and Inpatient level of care. The Financial Counselors are accountable for coordinating all activities necessary to financially secure the defined case load through the verification process; requesting deposits for non-covered services and co-pays; resolving complex problems that include but are not limited to pre-certifications; Utilization Management; coordination of benefits; baby not on policy; Cobra entitlement; Medicare Life Time Reserve days; and Medicare Advantage issues. Involves in-depth communication; collaboration; and follow-up with patients; families; third-party payers; governmental agencies; employers; social work; financial case management; and utilization management. The Financial Counselors are ultimately responsible for minimizing any delays from admission until the final bill is produced and any payer denials associated with the above.

This role may have the option to work a hybrid-remote schedule and communicate daily through virtual meetings.


Responsible for monitoring own performance on assigned tasks. Self-directed and must make complex decisions independently. May train other support staff.


Standard office equipment, including but not limited to: telephone, soft phone, page system, pneumatic tube system, personal computer, printer, photo copier, fax, RightFax, EPIC, Outlook, and third party verification systems.


Customer Interactions - 10 %:

Creates a professional and effective customer oriented environment by utilizing excellent communication skills to obtain pertinent demographic information; confirms insurance information; discusses financial obligation; documents demographic and insurance information in a timely, accurate manner in the hospital computer system following department and hospital standards.

Financial Management - 75 %:

  • Reviews each visit for insurance history by utilizing the hospital system along with all third party payer systems.

  • Obtains benefits; pre-certification requirements and/or completes notification of admissions.

  • Identifies and confirms self-pay patients for appropriate referral to Financial Case Management for possible Medicaid application and /or Financial Assistance.

  • Notifies and monitors parents for completion of adding newborns onto policy.

  • Notifies and monitors patients COBRA entitlement and assist with paperwork if necessary.

  • Determines the primary payer through knowledge of Medicare and other payer regulations for the coordination of benefits.

  • Notifies Utilization Management of clinical requests by third party payers.

  • Maintains a monitoring system for adequate benefit coverage and eligibility throughout the inpatient stay.

  • Accountable for meeting department standards for completion and QA of visits on a day to day basis by making sure missing registration items are complete and authorization obtained.

  • Reviews payer denials and communication from PFS related to Financial Counseling responsible areas and performs necessary follow-up to secure payment.

Quality Management- 1 5%:

  • Consistently monitors current admissions to ensure eligibility and additional clinical requirements.

  • Notifications of admission to third party payers are within the 24 hour or next business day-guideline.

  • Observes workqueue daily for potential cases that may require notification to insurance companies.

  • Ensures Medicare compliance with the Office of the Inspector General guidelines by notifying patients of exhausted Medicare benefits and the option of utilizing their lifetime reserve days.

  • Reviews Medicare for MSP questions and validation and ensures other coverage “covered through” field information is entered correctly. Investigates and corrects any discrepancy between MSPQ and patient registration.

  • Checks Medicaid eligibility every 30 days for active coverage.

  • Attends educational programs for the department at the Manager's direction.

  • May train or perform other duties assigned by management.


AAS in related discipline (admitting/registration/patient billing/insurance) with 3 years of related experience, preferably in a hospital setting, or an equivalent combination of education and experience. Require high degree of professionalism and motivation with excellent communication and customer service skills; strong computer skills and ability to type 45 words per minute. Strong ability to multi-task and prioritize. Prefer medical terminology. Flexible to work weekends, other assigned hours and/or responsibilities as needed.

NOTE : This document describes typical duties and responsibilities and is not intended to limit management from assigning other work as required.

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: $ 18.50 - $ 24.71 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: Strong Memorial Hospital
Full/Part Time: Full-Time