Referral & Prior Auth Rep III

Rochester, NY


The Financial Counselors assess all aspects of patient financial account management for all urgent and preadmission visits with an Ambulatory Surgery and Short Stay 23 Hour level of care and upgrades to Observation and Extended Recovery (with an associated Surgical Case). The Financial Counselors are accountable for coordinating all activities necessary to financially secure the defined case load through the verification process; requesting deposits for non-covered services and co-pays; resolving complex problems that include but are not limited to pre-certifications; Utilization Management; coordination of benefits; baby not on policy; Cobra entitlement; and Medicare Advantage issues. Involves in-depth communication; collaboration; and follow-up with patients; families; third-party payers; governmental agencies; employers; social work; financial case management; and utilization management. The Financial Counselors are ultimately responsible for minimizing any delays from admission until the final bill is produced.

This role may have the option to work a hybrid-remote schedule and communicate daily through virtual meetings.


Responsible for monitoring own performance on assigned tasks. Self-directed and must make complex decisions independently. May train other support staff.


Standard office equipment, including but not limited to: telephone, soft phone, page system, pneumatic tube system, personal computer, printer, photo copier, fax, RightFax, EPIC, Outlook, and third party verification systems.


Customer Interactions - 10 %:

  • Creates a professional and effective customer oriented environment by utilizing excellent communication skills to obtain pertinent demographic information; confirms insurance information; discusses financial obligation; documents demographic and insurance information in a timely, accurate manner in the hospital computer system following department and hospital standards.

Financial Management - 75 %:

  • Reviews each visit for insurance history by utilizing the hospital system along with all third party payer systems.

  • Obtains benefits and pre-certification requirements.

  • Obtains prior authorization for surgery on behalf of designated departments and sends supporting clinical from eRecord and AXIS to secure approval.

  • Identifies and confirms self-pay patients for appropriate referral to Financial Case Management for possible Medicaid application and /or Financial Assistance.

  • Notifies and monitors parents for completion of adding newborns onto policy.

  • Notifies and monitors patients COBRA entitlement and assist with paperwork if necessary.

  • Determines the primary payer through knowledge of Medicare and other payer regulations for the coordination of benefits.

  • Accountable for meeting department standards for completion and QA of visits on a day to day basis by making sure missing registration items are complete and authorization obtained.

Quality Management- 1 5%:

  • Observes workqueue daily for potential cases that may require notification to insurance companies.

  • Reviews Medicare for MSP questions and validation and ensures other coverage “covered through” field information is entered correctly. Investigates and corrects any discrepancy between MSPQ and patient registration.

  • Re-checks Medicaid eligibility for month of service.

  • Attends educational programs for the department at the Manager's direction.

  • May train or perform other duties assigned by management.


AAS in related discipline (admitting/registration/patient billing/insurance) with 3 years of related experience, preferably in a hospital setting, or an equivalent combination of education and experience. Require high degree of professionalism and motivation with excellent communication and customer service skills; strong computer skills and ability to type 45 words per minute. Strong ability to multi-task and prioritize. Prefer medical terminology. Flexible to work weekends, other assigned hours and/or responsibilities as needed.

NOTE : This document describes typical duties and responsibilities and is not intended to limit management from assigning other work as required.

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: $ 18.89 - $ 25.51 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: Strong Memorial Hospital
Full/Part Time: Full-Time