Top 27 Authorization specialist Jobs in Rochester Ny

Referral & Prior Authorization III
University of Rochester —Rochester, NY
- $20.30 - $27.41 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Pediatrics
Referral & Prior Auth Rep III
University of Rochester —Rochester, NY
- $20.30 - $27.41 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Medical terminology
5d
Referral Specialist
Unity Hospital of Rochester —Rochester, NY
- $19 - $24 an hour
- Full-time
- High school diploma or GED
- Clinic
- Neurology
Quick Apply
6d
Referral & Prior Auth III
University of Rochester —Rochester, NY
- $20.30 - $27.41 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Medical terminology
Billing Specialist
Vito C Quatela MD PLLC —Rochester, NY
- $22 - $26 an hour
- Full-time
- Writing skills
- Basic math
- Mid-level
- Health savings account
- Paid holidays
Quick Apply
Physician Support Rep III
University of Rochester —Rochester, NY
- $20.30 - $27.41 an hour
- Full-time
- Surgery
- Word processing
- Office
MEDICAL OFFICE SECRETARY / MEDICAL ASSISTANT
ROCHESTER PAIN SOLUTION —Rochester, NY
- $18 - $21 an hour
- Full-time
- Background check
- Vital signs
- Writing skills
- Profit sharing
- Paid time off
Quick Apply
Physician Support Representative
University of Rochester —Rochester, NY
- $20.30 - $27.41 an hour
- Day shift
- Mid-level
- High school diploma or GED
- Neurology
SCN Member Services Specialist
Forward Leading IPA —Rochester, NY
- $23 - $24 an hour
- Full-time
- Hybrid work
- Bilingual
- Nursing
- Mid-level
- Mileage reimbursement
- Health savings account
Quick Apply
Oncology Referral Specialist | Full Time Days | Lipson Cancer Institute - St Mary's
Unity Hospital of Rochester —Rochester, NY
- $19 - $24 an hour
- Full-time
- Medical office experience
- Mid-level
- 3 years
Quick Apply
12d
Patient Enrollment Specialist - Pharmacy
University of Rochester —Rochester, NY
- From $21.71 an hour
- Full-time
- Background check
- Mid-level
- University
- Health savings account
- Health insurance
Quick Apply
Medical Billing Specialist
Dermatology Associates of Rochester —Rochester, NY
- $18 - $20 an hour
- Full-time
- Surgery
- Computer literacy
- Medical office experience
- Health savings account
- Health insurance
Quick Apply
HIM SPECIALIST
ANTHONY L JORDAN HEALTH CORPORATION —Rochester, NY
- $18.00 - $20.80 an hour
- Full-time
- Computer literacy
- Medical office experience
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
Service & Support Specialist I
CooperVision —Victor, NY
- $21 - $22 an hour
- Extended hours
- Spanish
- Microsoft Outlook
- ERP systems
- Work from home
8h
Patient Relations Team Member
Dermatology Associates of Rochester —Rochester, NY
- $19 - $21 an hour
- Full-time
- Surgery
- HIPAA
- High school diploma or GED
- Health savings account
- Health insurance
Quick Apply
Medication Authorization Specialist
Rochester General Hospital —Rochester, NY
- $18 - $25 an hour
- Part-time
- Mid-level
- Continuous improvement
- Associate's degree
Quick Apply

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Referral & Prior Auth Rep III
University of Rochester —Rochester, NY
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Referral & Prior Authorization III

University of Rochester -
Rochester, NY

Apply Now

Job Details

Full-time
$20.30 - $27.41 an hour

Qualifications

Customer relationship building
Customer relationship management

Full Job Description

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):

601 Elmwood Ave, Room 10347J, Rochester, New York, United States of America, 14642

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

Department:

910083 Pediatrics Cardiology

Work Shift:

UR - Day (United States of America)

Range:

UR URCA 205 H

Compensation Range:

$20.30 - $27.41

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:

Oversees data and ensures compliance to enterprise standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and non-clinical staff, identifying barriers to appointment compliance, insurance company barriers and tracking all assistance provided. Plans, executes, appeals and follows through on all aspects of the process which has direct, multifaceted impact on patient scheduling, treatment, care and follow up. Adheres to approved protocols for working referrals and prior authorizations.

ESSENTIAL FUNCTIONS

Responsible for managing department referrals. Serves as liaison, appointment coordinator, and patient advocate between the referring office, specialists, and patient to assist in the coordination of scheduled visits and procedures incorporating all incoming referrals to the department. Conducts data analyses to track patient compliance with specialty services, consistently monitors the work queues, and communicates with referring and referred to departments to reconcile any discrepancies and/or answer any questions. Escalates case management when medical assessment is needed. Prioritizes referral requests using medical protocols, responding immediately and expediting most urgent requests. Requests and coordinates team and patient meetings as needed or requested by patient. Participates as an active member of the care team. Acquires insurance authorization for the visit and, if applicable, any testing and attaches referral records to any visits in which they are missing. Documents all communications pertaining to the referral and/or insurance authorization in the notes section of the electronic health record referral record. Performs a needs assessment using information from the electronic medical record to ensure the appropriate appointment/procedure is scheduled with the appropriate provider, ensuring accurate patient demographic and current insurance information is captured and adheres to RIM protocols for record verification. May perform complex appointment scheduling, linking referrals, and ancillary services for the assigned specialty service. Provides patients with appointment and provider information, directions to the office location, and any educational materials if appropriate. Provides regular data to team on patient compliance with treatment plans and strategies to improve patient compliance, including provider template oversight, reporting to manager any obstacles to timely scheduling. Ensures ancillary testing and other specialty referrals have been executed and results received and acted upon as needed. Investigates failure to receive such information, troubleshoots, resolves, and/or makes recommendations to ensure delivery/receipt.
Prepares and provides multiple, complex details to insurance or worker’s compensation carrier to obtain prior authorizations for both standard and complex requests, such as imaging, non-invasive procedures, sleep studies etc., communicating medical information to the insurance carrier and coordinating peer-to-peer reviews for denied services. Anticipates insurer’s various questions and prepares request by applying prior insurer decisions and specialty/sub-specialty knowledge of general medical experience and terminology, specialty and sub specialty medical office experience, International Classification of Diseases (ICD) and Current Procedure Technology (CPT), insurance policies, permissible and non-permissible requests, necessary and appropriate medical terminology to use in order for claim to be approved, previous treatments that are necessary to report, appropriate verbiage for treatments that have been tried and not successful. Applies knowledge and protocols to varying degrees based on how complexities of the situation deviate from the norm. Resolves obstacles presented by the insurance company by applying knowledge and experience of previous authorization requests, denials, and approvals. On behalf of the provider and the University, perseveres with the process to ensure as many applications are approved as possible without provider intervention. Determines relevant information needed, based on previous authorization request experience, for submission to carrier if first or second request is denied. Collaborates with provider to draft and finalize letter of medical necessity. Uses system tracking mechanisms to ensure all renewals/approvals are obtained prior to patient arrival.
Manages orders for patients being seen in ED/ Urgent Care. Demonstrates expert medical knowledge base with ability to recognize urgent clinical situations. Prioritizes referral requests, responding immediately and expediting most urgent requests. Reviews complex referral requests, evaluates, and schedules to the appropriate provider. Works with providers and other clinical staff to establish the best care plan for the patient.
Processes outgoing referrals. Discusses options with patient for outside URMC care. Ensures Meaningful Use requirements are met. Ensures the Summary of Care was transferred electronically via Epic to the referred to office; if the Summary of Care was not or cannot be transferred via Epic, takes additional steps to get this information to the referred to office either via facsimile or mail.
Processes incoming referrals not generated within the UR system. Completes referral entry for all external referrals into electronic health record following approved protocols. Coordinates any ancillary testing and obtains any outside records needed for patient appointment.

MINIMUM EDUCATION & EXPERIENCE

High School diploma or equivalent and 2 years of relevant experience required
Or equivalent combination of education and experience

KNOWLEDGE, SKILLS AND ABILITIES

Demonstrated customer relations skills required

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.

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Refine Your Search

authorization specialist jobs in rochester ny

Referral & Prior Authorization III

Referral & Prior Auth Rep III

Referral Specialist

Referral & Prior Auth III

Billing Specialist

Physician Support Rep III

MEDICAL OFFICE SECRETARY / MEDICAL ASSISTANT

Physician Support Representative

SCN Member Services Specialist

Oncology Referral Specialist | Full Time Days | Lipson Cancer Institute - St Mary's

Patient Enrollment Specialist - Pharmacy

Medical Billing Specialist

HIM SPECIALIST

Service & Support Specialist I

Patient Relations Team Member

Medication Authorization Specialist

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