Referral & Prior Auth Rep III

About the role

The University of Rochester community is defined by a deep commitment to Meliora - Ever Better, with shared values of equity, leadership, integrity, openness, respect, and accountability.

Job Location: 4901 Lac De Ville Blvd, Rochester, New York, United States of America, 14618.

Responsibilities

• Oversees data and ensures 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.
• Plans, executes, appeals and follows through on all aspects of the process which has direct, multifaceted impact on patient scheduling, treatment, care and follow up.
• Adheres to approved protocols for working referrals and prior authorizations.
• 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.
• 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.
• Acquires insurance authorization for the visit and, if applicable, any testing 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 electronic health record referral record.
• Performs a needs assessment using information from the electronic medical record to ensure the appropriate appointment/procedure is scheduled with the appropriate provider, ensuring accurate patient demographic and current insurance information is captured and 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, including 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 ensure delivery/receipt.
• Prepares and provides multiple