Rochester, NY, 14651, USA
1 day ago
Referral & Prior Auth Rep IV
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. **Job Location (Full Address):** 919 Westfall Rd, Bldg C, Rochester, New York, United States of America, 14618 **Opening:** Worker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500164 SMH Neurology Call Center Work Shift: UR - Day (United States of America) Range: UR URCB 206 H Compensation Range: $21.23 - $28.66 _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._ **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. **ESSENTIAL FUNCTIONS** + **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. **MINIMUM EDUCATION & EXPERIENCE** + 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 **KNOWLEDGE, SKILLS AND ABILITIES** + 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 The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture 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 characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law. Notice: If you are a **Current Employee,** please **log into myURHR** to search for and apply to jobs using the Jobs Hub. Your application, if submitted using this portal, cannot be moved forward. **Learn. Discover. Heal. Create.** Located in western New York, Rochester is our namesake and our home. One of the world’s leading research universities, Rochester has a long tradition of breaking boundaries—always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better. If you’re looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals. At the University of Rochester, we are committed to fostering, cultivating, and preserving an inclusive and welcoming culture and are united by a strong commitment to be ever better—Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.
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