Referral & Prior Auth Lead

Rochester, NY


The Referral & Prior Authorization Representative IV is a team leader responsible for supporting the surgeons, physicians, and advanced practice providers in their assigned division(s) in the departments of Orthopedic Surgery and Podiatry. 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.


Operations 20%

  • Supports supervisors and managers in developing and executing staffing plans

  • Responsible for oversight of daily work for Referral & Prior Authorization Rep III in their assigned division(s)

  • Regularly monitors pending and/or outstanding authorizations and executes prompt action to ensure timely completion

  • May cover the duties of Referral & Prior Authorization Representative III on their team as needed for coverage and/or for complex and/or urgent authorizations

Operational Excellence 30%

  • Enforces guidelines for prioritizing and assigning work activities, monitors procedures to enhance levels of service and quality including monitoring in-basket messaging pools, work-queues and other tasks

  • Serves as a subject matter expert for their assigned division(s) maintaining an in- depth understanding of all workflows and processes

Preceptorship/Training 20%

  • Responsible for training new team members, re-education of existing team members

  • Serves as a resource for training staff on new processes and other go lives including implementation of new technology, etc.

Leadership 30%

  • Ensures effective and efficient communication amongst the Physicians and their support services teams as related to the scope of their role

  • Serves as an advisor to the physician, APPs, and other members of the support serves team as appropriate and related to the scope of their role

  • Provides feedback to supervisors and managers for performance reviews


  • High school diploma or equivalent required

  • Associate degree in medical, Secretarial, billing or related field preferred

  • Minimum of 1 year of medical office or clinical experience required

  • 1-year experience working with insurance and prior authorization preferred

  • or equivalent combination of education and experience required

  • Demonstrated customer service skills required

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

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $19.91 - $26.88 Hourly

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

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Location: Medical Faculty Group
Full/Part Time: Full-Time