Referral & Prior Auth Rep III

We need to output HTML fragment with sections only if real content. The posting includes: Job location, worker subtype, time type, scheduled weekly hours, department, work shift, compensation range. Also responsibilities, typical duties (which are detailed), supervision and direction, machines and equipment used, qualifications. Also some boilerplate about values, EEO etc which we should remove. We need headings: About the role? Not present. The posting includes a description of community values but that's boilerplate; we can maybe include an "About the role" section? The instruction: use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). Use only when posting has real specific content. The posting includes responsibilities (the "Responsibilities" heading appears). Also "Typical Duties" could be considered responsibilities/duties; but we already have Responsibilities section. We could combine typical duties under Responsibilities. There's also "Supervision And Direction Exercised", "Machines And Equipment Used". Those could be under Requirements or Qualifications? Possibly "Qualifications" section includes education/experience, preferred skills. The posting includes "Qualifications" heading. Also "Machines And Equipment Used" could be under "Requirements" or "Skills". But we need to decide sections. We have compensation range: we can make a Pay section with the range. Also we have Scheduled Weekly Hours 40, Work Shift UR - Day. That could be Schedule section. We have location etc: could be minor metadata folded into a short p. We must not repeat job title as heading (not given). No Job ID. We must remove boilerplate: values statement, EEO, etc. We need to preserve all substantive information: location, worker subtype, time type, scheduled weekly hours, department, work shift, compensation range, responsibilities, typical duties, supervision and direction, machines and equipment used, qualifications. We need to format using

headings,

• for any list of duties/requirements/benefits, and

  for prose. We need to decide what constitutes a list. The responsibilities and typical duties are paragraphs with many sentences; could be turned into

  • items? The instruction: Use
    • for any list of duties/requirements/benefits. If the content is not already a list but prose, we could keep as

      . However we could break into list items for clarity but must preserve all info; turning prose into list items is okay as long as we don't lose info. Safer to keep as

      for prose, and only use

      • if there is an explicit list (like bullet points). The posting does not have explicit bullet list; it's paragraphs. So we will use

        for responsibilities and typical duties. But we could also treat "Typical Duties" as a heading and then list items? Not needed. We need sections: maybe "Responsibilities", "Qualifications", "Pay", "Schedule". Also maybe "Supervision and Direction" and "Machines and Equipment Used" could be under "Requirements" or "Qualifications". But we have a Qualifications section already; we could add those as additional details under Qualifications. Let's extract: - Job Location: 10 Miracle Mile Dr, Rochester, New York, United States of America, 14623 - Opening Worker Subtype: Regular - Time Type: Full time - Scheduled Weekly Hours: 40 - Department: 910234 Orthopaedic Appt Ctr - Work Shift: UR - Day (United States of America) - Compensation Range: $20.30 - $27.41 (hourly) - Responsibilities: paragraph starting "Serves as the patient referral and prior authorization specialist..." - Typical Duties: long paragraph with many details (Referral and Prior Authorization sections) - Supervision And Direction Exercised: paragraph - Machines And Equipment Used: paragraph - Qualifications: "High School Diploma and 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." We also have values statement etc which we drop. We need to decide headings: About the role? Not present; we could skip. Responsibilities: we have content. Qualifications: we have content. Pay: we have compensation range. Schedule: we have scheduled weekly hours and work shift. We could also include a short paragraph for location and other metadata under maybe "About the role" or just a

        before sections. The instruction: "Do NOT repeat the job title as a heading (the page already shows it) and do NOT put Job ID / requisition numbers as headings — fold minor metadata into a short

        or drop it." So we can include a short

        with location, worker subtype, time type, department, etc. Thus output:

        Job Location: 10 Miracle Mile Dr, Rochester, New York, United States of America, 14623. Worker Subtype: Regular. Time Type: Full time. Department: 910234 Orthopaedic Appt Ctr. Work Shift: UR - Day.

        Then sections:

        Responsibilities

        Serves as the patient referral and prior authorization specialist, with oversight of data and compliance to enterprise standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and non-clinical staff, identifying barriers to appointment compliance, insurance company barriers and tracking all assistance provided. 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. Adheres to approved protocols for working referrals and prior authorizations. Makes decisions that are guided by protocols and practices requiring some interpretation; maintains an expert level understanding of the department/division. May train new staff members.

        But we also have typical duties which are more detailed; we could incorporate them into Responsibilities section as additional paragraphs or as a list. Since they are substantive, we should include them. Perhaps we add another

        after responsibilities for typical duties. Thus:

        Responsibilities

        Serves as the patient referral and prior authorization specialist, with oversight of data and compliance to enterprise standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and non-clinical staff, identifying barriers to appointment compliance, insurance company barriers and tracking all assistance provided. 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. Adheres to approved protocols for working referrals and prior authorizations. Makes decisions that are guided by protocols and practices requiring some interpretation; maintains an expert level understanding of the department/division. May train new staff members.

        Typical Duties: Referral Responsible for managing department referrals. Serves as liaison, appointment coordinator, and patient advocate between the referring office, specialists and patient to assist in the coordination of scheduled visits and procedures incorporating all incoming referrals to the department using Epic Referral work queues. Conducts data analyses to track patient compliance with specialty services, consistently monitors the work queues and communicates with referring and referred to departments to reconcile any discrepancies and/or answer any questions. Escalates case management when medical assessment is needed. Prioritizes referral requests using medical protocols, responding immediately and expediting most urgent requests. Requests and coordinates team and patient meetings as needed or requested by patient. Participates as an active member of the care team. Acquire 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 attaches referral records to any visits in which they are missing. Documents all communications pertaining to the referral and/or insurance authorization in the notes section of the Epic referral record.Performs a needs assessment using information from the electronic medical record to assure the appropriate appointment/procedure is schedule with the appropriate provider; ensuring that accurate patient demographic and current insurance information is captured; adheres to RIM protocols for record verification. May perform complex appointment scheduling, linking referrals and ancillary services for the assigned specialty service. Provides patients with appointment and provider information, directions to the office location and any educational materials if appropriate.Provides regular data to team on patient compliance with treatment plans and strategies to improve patient compliance which includes provider template oversight, reporting to manager any obstacles to timely scheduling. Ensures ancillary testing and other specialty referrals have been executed and results received and acted upon as needed. Investigates failure to receive such information, troubleshoots, resolves, and/or makes recommendations to insure delivery/receipt. Prior Authorization Prior authorization functionality required for testing and services ordered by referred to specialist includes, preparing and providing multiple, complex details to insurance or worker's compensation carrier to obtain prior authorizations for both standard and complex requests such as imaging, non-invasive procedures, sleep studies etc., communicating medical information to the insurance carrier, and coordinating peer-to-peer reviews for denied services.Anticipates insurer's various questions and prepares request by applying prior insurer decisions and specialty/sub-specialty knowledge of general medical experience and terminology, specialty and sub specialty medical office experience, International Classification of Diseases (ICD) and Current Procedure Technology (CPT), insurance policies, permissible and non-permissible requests, necessary and appropriate medical terminology to use in order for claim to be approved, previous treatments that are necessary to report, appropriate verbiage for treatments that have been tried and not successful (i.e., medication could not be utilized due to heart condition). Applies knowledge and protocols to varying degrees based on how complexities of the situation deviate from the norm. Resolves obstacles presented by the insurance company 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.Determines relevant information needed, based on previous authorization request experience for submission to carrier if first or second request is denied. Collaborates with provider to draft and finalize letter of medical necessity. Uses system tracking mechanisms to ensure all renewals/approvals are obtained prior to patient arrival.Manages orders for patients being seen in ED/ Urgent Care. Demonstrates expert medical knowledge base with ability to recognize urgent clinical situations. Prioritizes referral requests, responding immediately and expediting most urgent requests. Reviews complex referral requests, evaluates and schedules to the appropriate provider. Works with providers and other clinical staff to establish the best care plan for the patient.Processes outgoing referrals. Discusses with patient options for outside URMC options for care. Assures Meaningful Use requirements are met. Ensures that the Summary of Care was transferred electronically via Epic to the referred to office; if the Summary of Care was not or cannot be transferred via Epic, additional steps will be taken to get this information to the referred to office either via facsimile or mail.Processes incoming referrals not generated within the UR system. 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. Supervision And Direction Exercised Receives minimal direction from physician, mid-level providers, department head and/or administrative assistant or administrator. Is responsible for independently planning, executing and evaluating own work. Works independently with latitude for action. Machines And Equipment Used Standard office equipment.

        But that's huge; maybe better to split into sections: Responsibilities, Typical Duties, Supervision and Direction, Machines and Equipment Used. However instruction says prefer few substantive sections over many thin ones. Could combine Typical Duties under Responsibilities as it's essentially duties. Supervision and Direction and Machines and Equipment Used could be under Qualifications or Requirements. But we have Qualifications section already; we could add those as extra paragraphs under Qualifications. Thus:

        Qualifications

        High School Diploma and a minimum of two years of relevant experience