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Referral & Prior Auth Rep IV

urmc.rochester.edu Logo

University of Rochester

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Location:
United States of America , Rochester

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Contract Type:
Not provided

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Salary:

21.23 - 28.66 USD / Hour

Job Description:

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.

Job Responsibility:

  • 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
  • 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

Requirements:

  • 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
  • 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

Nice to have:

  • Medical terminology preferred
  • 2–3 years in referral/prior authorization or care coordination, including neurology or another complex specialty preferred
  • Prior neurology specialty experience
  • Familiarity with specialty medications and testing workflows

Additional Information:

Job Posted:
February 20, 2026

Employment Type:
Fulltime
Work Type:
On-site work
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