|Referral & Prior Authorization|
Company: University of Rochester
Location: Rochester, NY
Employment Type: Full Time
Date Posted: 04/06/2021
Expire Date: 06/10/2021
Job Categories: Administrative and Support Services, Advertising/Marketing/Public Relations, Computers, Software, Finance/Economics, Healthcare, Practitioner and Technician, Human Resources, Information Technology, Insurance, Internet/E-Commerce, Collegiate Faculty, Staff, Administration, Research & Development, Medical, Web Technology
Referral & Prior Authorization|
Referral & Prior Authorization
Job ID: 226408
Location: Strong Memorial Hospital
Full/Part Time: Full-Time
Full Time 40 hours Grade 009 Imaging Sciences-Pre Auth
With minimum direction and considerable latitude for independent judgment, obtains prior authorizations for both standard and complex requests. Provides multiple and complex details to insurance carrier by anticipating their questions when reviewing and retrieving relevant information from the electronic medical record. Is 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.
SUPERVISION AND DIRECTION RECEIVED:
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.
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.
Uses independent judgment to examine, research and assemble necessary patient information via the scheduling system and multiple areas of the electronic medical record. Decides, based on previous authorization approvals and denial experience, the relevant information to be included in the request.
Prepares and provides multiple, complex details and facts to insurance carrier or worker's compensation carrier to obtain prior authorizations for both standard and complex requests such as invasive procedures and complicated surgeries but also for medication, imaging, non-invasive procedures, sleep studies etc.
Anticipates insurer's various questions and prepares request by applying prior insurer decisions and specialty/sub-specialty knowledge of the following:
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.
Develops and utilizes and modifies tracking mechanisms to ensure all renewals/approvals are obtained prior to patient arrival.
Participates in recruiting, hiring and promotion decisions. Completes performance evaluations. Monitors staff performance.
Associate's degree in Medical, Secretarial or related field and a minimum of three years of relevant experience required; or an equivalent combination of education and experience. Medical Terminology, experiences with surgical/appointment scheduling software (such as Flowcast), and electronic medical records, preferred. Demonstrated customer relations skills.
How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled
To apply, visit https://ps.its.rochester.edu/psp/PSApplyOnline/EMPLOYEE/HRMS/c/HRS_HRAM_FL.HRS_CG_SEARCH_FL.GBL?Page=HRS_APP_JBPST_FL&Action=U&FOCUS=Applicant&SiteId=1&JobOpeningId=226408&PostingSeq=1
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