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University of Rochester Referral & Prior Auth Spec - 232348 in Rochester, New York

Referral & Prior Auth Spec Job ID 232348

Location Strong Memorial Hospital Full/Part Time Full-Time Favorite Job Regular/Temporary Regular Opening

Full Time 40 hours Grade 010 Amb Medication Prior Auth

Schedule

8 AM-4:30 PM

Responsibilities

POSITION SUMMARY:

Oversees and provides direction to Prior Authorization Associates and Specialists; trains new employees, resolves problems and issues, monitors quality assurance of daily operations and provides coaching and training support.

SUPERVISION AND DIRECTION EXERCISED:

Provides direction and supervision to Prior Authorization Associates and Specialists assigns and checks work. Assists supervisor in preparing performance evaluation data and provides input into salary increase recommendation process. Assumes functions of supervisor in his/her absence.

MACHINES AND EQUIPMENT USED:

Standard office equipment including computer, calculator, telephone, facsimile. Will use software for electronic medical record system, appointment scheduling system, and Operating Room scheduling system and other systems as needed.

TYPICAL DUTIES:

  • Coordinates daily assignments of Prior Authorization Associates and Specialists to manage authorization processes.

  • Serves as a focal point for answering questions and solving problems for difficult and unusual authorizations, assists in problem identification, quantification, and resolution.

  • Performs quality assurance monitoring for activities completed in area of immediate responsibility as well of other areas that affect it; using specific criteria, measures quality, quantity and timeliness of tasks performed; prepares related logs and management reports. Communicates accuracy to staff and manager.

  • Collaborates with other Lead Prior Authorization Specialists across programs to establish best practice standards, disseminates those standards and implements and monitors the adherence to those standards.

  • Implements and monitors procedures for enhancing levels of service and quality. Develops guidelines for prioritizing and assigning work activities, evaluating effectiveness and modifying processes as necessary.

  • Participates in recruiting, hiring and promotion decisions. Completes performance evaluations. Promptly and accurately completes required documentation related to hires, terminations, and other status changes. Monitors staff performance; counsels staff regarding performance issues. Adjusts staff schedule and duties as necessary using experienced judgment. Manages and approves staff requests for time off and overtime. Oversees time approval.

  • Provides training to Prior Authorization Associates and Specialists on all aspects of referral work, including the following:

  • Electronic medical record system support,

  • Patient record review,

  • Knowledge of provider sub-specialties and

  • Collection of additional information from provider to submit to insurance carrier when needed

  • Acts as information resource. Attends educational programs for department at direction of supervisor and teaches other staff.

  • Performs duties of Prior Authorization Specialist as required particularly for those more complex referral requests. Achieves and maintains proficiency in provision of excellent customer service, accuracy and efficiency of work.

    Qualifications :

Associate’s degree in Medical, Secretarial or related field and a minimum of three years of relevant experience required with 1 year of demonstrated leadership experience ; or an equivalent combination of education and experience. Medical Terminology, experiences with surgical/appointment scheduling software (such as Flowcast), and electronic medical records, preferred. Demonstrated customer relations skills.

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

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

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