Referral & Prior Auth Rep III

University of Rochester•Minneapolis, MN

9d•$20 - $26•Onsite

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. Manages, processes and tracks the Department of Neurosurgery referrals and prior authorizations in compliance with university standards. Communicate regularly with 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 impact on patient scheduling, treatment, care and follow up. Adheres to approved protocols for working referrals and prior authorizations.

Requirements

High School diploma or equivalent and 2 years of relevant experience required or equivalent combination of education and experience required
Demonstrated customer relations skills required

Nice To Haves

Medical Terminology, experience with surgical/appointment scheduling software and electronic medical records preferred

Responsibilities

Responsible for managing department referrals.
Serves as liaison, appointment coordinator, and patient advocate between the referring office, and patient to assist in the coordination of scheduled visits and procedures incorporating all incoming referrals to the department.
Conducts data analyses to track compliance within Neurosurgery, to monitor work queues, and communicates with referring departments to reconcile any discrepancies and/or answer any questions.
Prioritizes referral requests using medical protocols.
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.
Ensures the appropriate appointment/procedure is scheduled with the appropriate provider, ensuring accurate patient demographic and current insurance information is captured.
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.
Prepares and provides multiple, complex details to insurance, worker’s compensation or VA to obtain prior authorizations for both standard and complex requests for the Department of Neurosurgery.
Anticipates insurer’s various questions and prepares request by applying (ICD) and Current Procedure Technology (CPT), insurance policies, permissible and non-permissible requests, necessary and appropriate medical insurer decisions to be approved, previous treatments that are necessary to report, appropriate verbiage for treatments that have been tried and not successful.
Determines relevant information needed, based on previous authorization request experience, for submission to carrier if first or second request is denied.
Uses system tracking mechanisms to ensure all renewals/approvals are obtained prior to patient arrival.
Processes incoming referrals not generated within the UR system.
Completes referral entry for all external referrals into electronic health record following approved protocols.
Coordinates any ancillary testing and obtains any outside records needed for patient appointment.
Processes outgoing referrals.
Discusses options with patient for outside URMC care.
Ensures Meaningful Use requirements are met.
Ensures the Summary of Care was transferred electronically via Epic to the referred to office; if the Summary of Care was not or cannot be transferred via Epic, takes additional steps to get this information to the referred to office either via facsimile or mail.
Manages referral orders for patients previously seen in the ED/ Urgent Care.
Demonstrates expert medical knowledge base with ability to recognize urgent clinical situations.
Prioritizes referral requests, responding immediately and expediting most urgent requests.
Reviews complex referral requests, evaluates, and schedules to the appropriate provider.
Works with providers and other clinical staff to establish the best care plan for the patient.
Other duties as assigned.