Referral & Prior Authorization - University of Rochester

POSITION SUMMARY: With general direction and latitude for initiative and judgment performs routine and non- routine administrative duties to monitor and process department's referrals. Is accountable for completing all referrals in a manner compliant with University standards. The majority of referrals processed are those received by the department but also processes those prescribed by the department's providers. **SUPERVISION AND DIRECTION RECEIVED:** Receives minimal direction from physician, mid-level providers, department head and/or administrative officer. Is responsible for independently planning, executing and evaluating own work. **SUPERVISION AND DIRECTION EXERCISED:** Directs other secretarial and clerical assistants. May train and coordinate activities of peers or support staff. **MACHINES AND EQUIPMENT USED** : Standard office equipment including computer, calculator, telephone, facsimile. Will use software for electronic medical record system, appointment scheduling system, and Operating Room scheduling system and other systems as needed. **TYPICAL DUTIES:** In processing referrals for receiving providers as well as prescribing providers, prioritizes referrals by following and applying standard policies, procedures and practices. Employs multiple tracking mechanisms to ensure that referral approvals and appointments are obtained in a timely way so that patients are always cleared for their appointment prior to their arrival. Enters progress notes and other pertinent information into the electronic medical record based on application of practices and procedures. Specific blend of referral duties may vary and are related to the department structure and business needs: **Receiving Provider** Reviews referrals to determine if insurance authorization has been obtained. If no authorization, returns referral to referring providerls office via electronic medical record system. Identifies, by applying knowledge of provider sub-specialties,the appropriate provider with whom to make an appointment. Schedules required ancillary services needed to prepare for appointment. Follow up with patient to ensurecompleteness. Explains whether provider participates in patientls insurance and if not, describes options for payment. Conveys instructions to patients for appointment by applying the appropriate protocol. Enters scheduled appointment information into electronic medical record for referring provider office to view. Assembles, from multiple tabs within the electronic medical record, the necessary details to identify what referral is needed. Determines if preliminary testing (i.e. Imaging) is needed based on office practices and procedures and is responsible for explaining to patient, assisting with scheduling and for completeness prior to office visit. Anticipates, gathers and sends information to insurance carrier and/or provider needed for obtaining referral or prior authorization for required preliminary testing. Completes the referral request in the electronic medical record system once the patient has been seen by entering a new status as closed. **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. Associates Degree in Medical, Secretarial or related field is preferred. 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._ Apply for Job + Careers + Sign In + New User **Location:** Medical Faculty Group **Full/Part Time:** Full-Time **Opening:** **Schedule:**