Referral & Prior Auth Rep IV

University of Rochester

22h • $21 - $29

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. Responsibilities: Leads and executes referral coordination and prior authorization workflows for Adult Neurology, ensuring accurate, timely, and compliant processing of referrals, testing, procedures, and specialty visits. Oversees workqueue distribution, provides day-to-day guidance and escalation support, and serves as liaison among patients, providers, clinical teams, and payers. Drives access, quality, and financial outcomes by applying neurology-specific knowledge, optimizing workflows, and training staff on standard work and system use.

Requirements

• High School diploma or equivalent required
• 3 years of relevant experience required
• 1 year of demonstrated leadership experience required
• 2–3 years in referral/prior authorization or care coordination, including neurology or another complex specialty preferred or equivalent combination of education and experience

Nice To Haves

• Medical terminology preferred
• EMR proficiency (e.g., appointment and imaging order workflows)
• Knowledge of payer prior authorization processes
• Strong communication and customer service
• Organizational and critical thinking skills
• Ability to prioritize in a fast-paced environment
• Prior neurology specialty experience
• Experience overseeing work queues
• Familiarity with specialty medications and testing workflows

Responsibilities

• Referral & Prior Authorization Management: Prepare, submit, and track prior authorizations for neurology specialty visits, and outgoing referrals; verify benefits; document determinations and follow-ups in the EMR.
• Workqueue, Throughput & Team Leadership: Monitor and assign referrals across multiple neurology workqueues; balance workload, set priorities, and provide real-time guidance and escalation support; delegate tasks to meet turnaround targets.
• Neurology Referral Coordination & Scheduling: Validate medical necessity and ICD-10/CPT details; coordinate internal/external specialty visits (e.g., epilepsy, CB, neuroimmunology, movement disorders, stroke, headache) and reconcile outside radiology imaging in the EMR.
• Patient/Provider Communication & Access: Serve as liaison to patients, neurologists, APPs, nurses, and external offices; provide clear updates, instructions, and education; triage urgent cases and expedite time-sensitive referrals.
• Quality Improvement, Compliance & Training: Audit referral accuracy and timeliness; maintain documentation standards (e.g., HIPAA); update SOPs and tip sheets; train/onboard staff and champion workflow improvements and standard work.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED