University of Rochester
Referral & Prior Auth Rep IV
University of Rochester, Rochester, New York, United States, 14600
Job Title
As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive. Job Location: 601 Elmwood Ave, Rochester, New York, United States of America, 14642 Opening: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 400140 Surgery Central Administration Work Shift: UR - Day (United States of America) Range: UR URCB 205 H Compensation Range: $20.31 - $27.42 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. Responsibilities
General Purpose: Oversees and provides direction to lower-level team members, including serving as point of contact to answer questions and solve problems for difficult and unusual authorizations and referrals. Assists in problem identification, quantification and resolution. Trains new employees. Resolves problems and issues. Monitors quality assurance of daily operations. Provides coaching and training support. Maintains department authorization processes to ensure adaptation to best practice. Monitors and distributes key information from payers regarding policy updates. Serves all divisions under the Department of Surgery. Essential Functions
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. Performs and maintains proficiencies of the duties of Referral & Prior Auth Rep III. Provides training to lower-level staff on all aspects of missing referral workqueue, 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 relating to prior-authorization and other areas that affect it, utilizing specific criteria. Measures quality, quantity, and timeliness of tasks performed. 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 others to establish best practice standards. Disseminates those standards and implements and monitors the adherence to those standards. Coordinates daily assignments of lower-level staff with division leadership. Participates in recruiting, hiring, and promotion decisions. Assists with performance evaluations. Monitors authorization related KPIs including completion, accuracy, and denial rate. Coaches staff regarding authorization performance issues in collaboration with division manager. Acts as resource for information. Attends educational programs for department at the direction of supervisor. Educates other staff on materials. Other duties as assigned. Minimum Education & Experience
High School diploma or equivalent Required 3 years of relevant experience Required 1 year of demonstrated leadership experience Required or equivalent combination of education and experience Preferred Knowledge, Skills and Abilities
Demonstrate Customer Service Skills Preferred Medical Terminology Preferred Surgical/appointment scheduling software, such as Flowcast Preferred Experience navigating payer websites and electronic medical records Preferred The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture 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 characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.
As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive. Job Location: 601 Elmwood Ave, Rochester, New York, United States of America, 14642 Opening: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 400140 Surgery Central Administration Work Shift: UR - Day (United States of America) Range: UR URCB 205 H Compensation Range: $20.31 - $27.42 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. Responsibilities
General Purpose: Oversees and provides direction to lower-level team members, including serving as point of contact to answer questions and solve problems for difficult and unusual authorizations and referrals. Assists in problem identification, quantification and resolution. Trains new employees. Resolves problems and issues. Monitors quality assurance of daily operations. Provides coaching and training support. Maintains department authorization processes to ensure adaptation to best practice. Monitors and distributes key information from payers regarding policy updates. Serves all divisions under the Department of Surgery. Essential Functions
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. Performs and maintains proficiencies of the duties of Referral & Prior Auth Rep III. Provides training to lower-level staff on all aspects of missing referral workqueue, 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 relating to prior-authorization and other areas that affect it, utilizing specific criteria. Measures quality, quantity, and timeliness of tasks performed. 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 others to establish best practice standards. Disseminates those standards and implements and monitors the adherence to those standards. Coordinates daily assignments of lower-level staff with division leadership. Participates in recruiting, hiring, and promotion decisions. Assists with performance evaluations. Monitors authorization related KPIs including completion, accuracy, and denial rate. Coaches staff regarding authorization performance issues in collaboration with division manager. Acts as resource for information. Attends educational programs for department at the direction of supervisor. Educates other staff on materials. Other duties as assigned. Minimum Education & Experience
High School diploma or equivalent Required 3 years of relevant experience Required 1 year of demonstrated leadership experience Required or equivalent combination of education and experience Preferred Knowledge, Skills and Abilities
Demonstrate Customer Service Skills Preferred Medical Terminology Preferred Surgical/appointment scheduling software, such as Flowcast Preferred Experience navigating payer websites and electronic medical records Preferred The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture 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 characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.