Referral & Prior Auth Rep IV Job at University of Rochester (Rochester)

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

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Referral & Prior Auth Rep IV

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