Referral and Prior Auth Rep-Imaging

University of Rochester•New York, NY

13d•$20 - $27•Remote

About The Position

The Referral and Prior Auth Rep manages referrals and insurance prior authorizations for the Imaging Sciences-Pre Auth department. The role serves as a liaison, appointment coordinator, and patient advocate among patients, referring offices, specialists, and clinical teams, helping coordinate visits, procedures, and follow-up care. It uses electronic health records and approved protocols to assess needs, schedule appropriate appointments, track patient compliance, document communications, and address barriers to timely care. The position prepares and submits standard and complex authorization requests, communicates medical information to insurers, follows up on denials and appeals, coordinates peer-to-peer reviews, and works with providers on letters of medical necessity. It also handles urgent and complex referrals, including orders from emergency and urgent care settings, and manages incoming and outgoing referrals and the associated transfer of records. This is a full-time, remote position based in New York, with a day shift and 40 scheduled hours per week.

Requirements

High school diploma or equivalent and 2 years of relevant experience, or an equivalent combination of education and experience.
Demonstrated customer relations skills.

Nice To Haves

Medical terminology knowledge.
Experience with surgical or appointment scheduling software.
Experience with electronic medical records.

Responsibilities

Manage department referrals and serve as a liaison, appointment coordinator, and patient advocate among referring offices, specialists, and patients.
Monitor work queues, analyze and report patient compliance with specialty services, and communicate with departments to resolve discrepancies and answer questions.
Prioritize referrals using medical protocols, expedite urgent requests, escalate cases requiring medical assessment, and coordinate meetings when needed.
Obtain insurance authorization for visits and related testing, attach missing referral records, and document referral and authorization communications in the electronic health record.
Assess patient needs using the electronic medical record; ensure appropriate appointments and procedures are scheduled with the appropriate provider and verify demographic and insurance information.
Perform complex appointment scheduling, link referrals and ancillary services, and provide patients with appointment details, directions, and educational materials as appropriate.
Report obstacles to timely scheduling and provide the team with information on patient compliance and strategies to improve it.
Ensure ancillary testing and specialty referrals are completed and results are received and acted upon; investigate and resolve failures in delivery or receipt.
Prepare and submit prior authorization requests to insurers or workers’ compensation carriers, follow up on denials, coordinate peer-to-peer reviews, and work with providers on letters of medical necessity.
Use tracking mechanisms to ensure renewals and approvals are obtained before patients arrive.
Manage orders for patients seen in emergency departments and urgent care, review complex requests, schedule with appropriate providers, and collaborate on care plans.
Process outgoing referrals, discuss outside-care options with patients, and ensure required summaries of care are transferred electronically or by fax or mail.
Enter external incoming referrals into the electronic health record and coordinate ancillary testing and outside records needed for appointments.
Perform other duties as assigned.