NPV Referral and Prior Authorization Coordinator

Responsibilities

• Performs complex secretarial and administrative duties, in a fast-paced environment with minimal direction and considerable latitude for independent judgment, in support of the clinical, educational, and academic programs for the Faculty of Thoracic and Foregut Surgery.
• Patient Scheduling and Coordination of Care
• Receives incoming patient telephone calls for surgeon(s) and nurse practitioner(s), managing and/or resolving various scheduling/coordination issues and answering questions as needed.
• Coincides scheduling of patients at multiple practice sites; coordinates referrals for consults.
• Triages telephone calls from patients and referring physicians to surgeons, residents and nurse practitioners.
• Processes incoming referrals not generated within the UR system.
• Enters faxed referrals into the record system.
• Safeguards ancillary testing and other specialty referrals have been executed and results received and acted upon as needed.
• Investigates failure to receive such information, troubleshoot, resolve, and/or make recommendations to ensure delivery/receipt.
• Acquires insurance authorization for the visit and, if applicable, any testing; insurance authorization information will be entered in the Epic referral record for the patient, and referral records to any visits in which they are missing.
• Provides patients with appointment and provider information, directions to the office location, and any educational materials if appropriate.
• Documents all communications pertaining to the referral and/or insurance authorization in the notes section of the Epic referral record.
• May perform complex appointment scheduling, linking referrals and ancillary services for the assigned specialty service.
• Makes decisions that are guided by protocols and practices requiring some interpretation; maintains an expert-level understanding of the department/division.
• Prior authorization functionality will be required for testing and services ordered by referred-to specialists, including but not limited to:
• Prepares and provides multiple, complex details and facts to the insurance carrier or worker’s compensation carrier to obtain prior authorizations for standard and complex requests such as imaging, non-invasive procedures, sleep studies, etc.
• Communication of medical information to the insurance carrier.
• Completes referral entry for all external referrals into Epic following approved protocols.
• Coordinates any ancillary testing and obtains any outside records needed for patient appointment.
• Ability to prioritize referral requests, responding immediately and expediting most urgent requests.
• Reviews complex referral requests, evaluates them, and schedules them with the appropriate provider.
• Works with providers and other clinical staff to establish the best care plan for the patient.
• Schedules appointments, tests, and surgeries, coordinating appointments, tests, and consults in preparation for surgery or further clinical work-up.
• Acquires prior authorizations for different X-rays and scans, which requires detailed filling out of specific request forms with patient’s medical information outside of URMC.
• It also includes getting prior authorization for surgeries that may require speaking with insurance company nurses and giving specific health information from patients’ records to get approval.
• Interacts effectively in carrying out these responsibilities, presenting a positive image for the Division of Thoracic and Foregut Surgery.
• Works regularly with URMC patient registration and clinical information systems.
• Documents and Information Management
• Documents telephone encounters in eRecord, completion/submission of patient care and insurance documents.
• Coordinates maintenance of patient records, documentation for billing, and completion/submission of documents regarding patient care and insurance.
• Transcribes proofreads and ensures accuracy and timeliness of all written materials, including medical reports and correspondences.
• Demonstrates knowledge of medical terminology, word processing, spreadsheets, and presentation software.
• Researches hospital medical records for the information requested by physicians, insurance companies, and attorneys.
• Occasionally composes, takes minutes, types, and signs nonroutine correspondence providing factual information.
• Time and Calendar Management
• Functions as one of the points of contact for the surgeons and APP's of the Thoracic and Foregut Division of Surgery.
• Effectively balances competing demands of surgeon time by managing calendar, including all clinical activity, administrative meetings, research, education and academic commitments.
• Other Office Management
• Assists in managing all incoming mail for surgeon(s) and nurse practitioner(s), assuring that all correspondence receives timely attention and is followed up appropriately.
• Assists with training incoming new secretaries or temporary secretaries when requested.
• Functional knowledge of various office equipment.
• Provides coverage for absences within the division, off-site practice location if needed, and within the department when requested.

Qualifications

• High School diploma or equivalent and 2 years of relevant experience required.
• Associate's degree in Medical, Secretarial, billing, or related field preferred.
• Or equivalent combination of education and experience.
• Medical Terminology, experience with surgical/appointment scheduling software and electronic medical records preferred.

Skills and Abilities

• Demonstrated customer relations skills required.
• Medical Terminology, experiences with surgical/appointment scheduling software, and electronic medical records preferred.
• Excellent interpersonal skills, customer service skills, and organizational skills preferred.
• Strong attention to detail and communication skills, including written communication preferred.
• Working knowledge of word processing and spreadsheet applications preferred.
• Experience in medical office setting preferred.
• eRecord, Cadence, and medical terminology preferred.