Referral & Prior Auth Rep III

University of Rochester•Town of Brighton, NY

13d•$20 - $26

About The Position

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive. With minimum direction and considerable latitude for independent judgment, performs routine and non-routine secretarial duties supporting the Developmental and Behavioral Pediatrics Clinical Services. Communicates directly with families seeking service; oversees quality processes related to paperwork and electronic medical record; manages insurance referral process; coordinates supplies for clinic rooms. Position requires extensive experience with University and departmental policies, procedures and practices. Demonstrates ICARE values in each of the major responsibilities.

Requirements

High school diploma required
2 years of relevant experience or equivalent combination of education and experience required
The individual must possess well-developed communication skills, including excellent spelling and grammar; advanced secretarial skills, including expertise in Microsoft Office applications, various other software and databases.
Excellent organizational, interpersonal and computer skills are required.
This position requires an annual re-certification in HIPAA awareness, and annual renewal of a Strong Commitment contract.
Incumbent must demonstrate dedication to professional development with at least forty hours of training or development activities annually.

Responsibilities

Oversees referrals, prior authorizations and challenging billing situations.
Acts promptly to resolve referral issues resulting from last-minute changes a patient’s insurance.
Communicates with Pediatric Billing office on a regular basis to stay current with referral requirements for all insurers.
Oversees all insurance approvals and prior authorizations required for medication, equipment, and nutritional supplements.
Reviews provider notes and past medications in order to supply needed information to insurer
Completes insurance-required forms and documentation, submitting per insurance-specific method.
Responds to denials, collaborating with family, office staff, and providers in order to resolve issues.
Acts as a resource for other support staff in regard to insurance & referral issues.
Is responsible for submitting billing for any in-patient services by the DBP providers.
Oversees development and implementation of systems to assure needed insurance authorizations are completed prior to clinical visits.
Monitors schedule for patients visits requiring referrals or prior authorizations
Completes needed forms, collects needed information or justification, and transmits it to the insurer
Maintains up-to-date tracking system to monitor insurance response and submit additional information when needed.
Communicates with clinical leadership regarding authorization denials.
Schedules peer-to-peer meetings when needed.
Communicates any limits on the visit to the provider prior to the visit date.
Assures that all details needed for insurance reimbursement are completed in a timely manner, well ahead of the scheduled visit.
Oversees My Chart sign-up process for the division.
Takes requests from providers to give parents proxy to their child’s My Chart record.
Facilitates My Chart process for parents who have questions or difficulty with it.
Acts as a resource to support staff team regarding My Chart.
Shares responsibility for answering busy clinic phone lines & triaging calls appropriately.
Assesses family requests & schedules appropriate appointments for patients in DBP clinic.
Takes detailed messages for medical providers & assures timely responses to families.
Shares in reviewing & triaging volumes of faxed material received in clinic office each day.
Attends clinic one day per week to register patients, verify insurance & assist in managing follow-up recommendations.
Manages the flow of paperwork & records within the clinic practice.
Reviews all patient paperwork received by mail & triages it appropriately.
Updates and maintains supply of materials used by providers in clinic rooms.
Troubleshoots as necessary when information is difficult to locate.
Tracks the supply of all testing materials used in the clinic & processes orders for new materials as needed.
Tracks office supplies & initiates orders as necessary.
Completes other secretarial and administrative duties as required, including copying, faxing, etc.
Other duties as assigned