Referral & Prior Auth Rep IV

University of Rochester•Town of Brighton, NY

1d•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. This role is a Full Time position with a scheduled weekly hour of 40. The department is CVSL RCPG & Cardiac Rehab and the work shift is UR - Day.

Requirements

High School diploma or equivalent and 3 years of relevant experience required Or equivalent combination of education and experience
1 year of demonstrated leadership experience required

Nice To Haves

Medical terminology preferred
Surgical/appointment scheduling software, such as Flowcast preferred
Electronic medical records preferred

Responsibilities

Oversees and provides direction to lower level team members, including serving as point of contact to answer questions and solve problems for difficult and unusual authorizations and referrals.
Assists in problem identification, quantification and resolution.
Trains new employees.
Resolves problems and issues.
Monitors quality assurance of daily operations.
Provides coaching and training support.
Serves as point of contact to answer questions and solve problems for difficult and unusual authorizations and referrals.
Assists in problem identification, quantification, and resolution.
Provides training to lower level staff on all aspects of referral work, including electronic medical system support, patient record review, appointment and/or ancillary test scheduling, procedural scheduling, knowledge of provider sub-specialties, and collection of additional information from provider or electronic medical system to submit to insurance carrier when needed.
Performs quality assurance monitoring for activities in area of immediate responsibility and other areas that affect it, utilizing specific criteria.
Measures quality, quantity, and timeliness of tasks performed.
Prepares related logs and management reports.
Implements and monitors departmental/office specific procedures, to work in conjunction with enterprise established processes, for enhancing levels of service and quality.
Develops departmental/office guidelines for prioritizing and assigning work activities, evaluates effectiveness, and modifies processes as necessary.
Collaborates with others to establish best practice standards.
Disseminates those standards and implements and monitors the adherence to those standards.
Coordinates daily assignments of lower level staff.
Participates in recruiting, hiring, and promotion decisions.
Assists with performance evaluations.
Monitors staff performance and counsel’s staff regarding performance issues.
Manages and approves staff requests for time off and overtime.
Adjusts schedule and duties as necessary.
Acts as resource for information.
Attends educational programs for department at the direction of supervisor.
Educates other staff on materials.
Other duties as assigned.