Authorization Utilization Review Bcba Jobs in Rochester, NY

Rochester General MOB

Full time

REQ_241284

Job Title: Administrative Coordinator

Status: Full Time Department: Imaging Services Location: Rochester General MOB - 1415 Portland Avenue Rochester, NY 14621 Schedule: Days, M-F, 8 hrs, Negotiable 8am-430pm or 830am-5pm

SUMMARY

Participates and supports oversight of office processes of the Medical Management Department to maintain daily operations. Oversees the daily review process of the third party payors ensuring information is tracked and trended for reporting purposes. Acts as a liaison and collaborates with Patient Financial Services and Patient Access to assure authorization requirements of third party payors are maintained. Creates departmental reports for senior management

RESPONSIBILITIES

• Oversees the review process of third party payors with oversight from the Director of Care Management. Provides daily oversight of the onsite review activities of third party payors identifying issues and cases for appeal.

• Collaborates and acts as liaison with Patient Access and Patient Financial Services to assure required authorizations requirements of Third Party Payors are maintained.

• Participates and supports the medical management department in the tracking, trending and reporting of appeals and charge recovery information.

• Conducts reviews of cost outliers and collaborates with other hospital operating areas to recover billed charges. Tracks reporting activities and prepares reports for management presentation.

• Provides ongoing support for the tracking and trending of the Reimbursement Specialist charge recovery activities.

• Assists with special projects including but not limited to data collection, compilation, and analysis as defined by management. Assists in the design and implementation of procedures and work plan for special medical management studies/reports required to ensure regulatory compliance.

• Provides ongoing support to the Utilization Committee as assigned.

• Provide ongoing resource and support to the department for clinical pathway process including tool development.

• Manages confidential information in accordance with RGHS policy and procedures.

• Screen patients at risk with no, or inadequate health insurance coverage for immediate and chronic needs.

• Implements plan to facilitate eligibility

• Represents Rochester General Medical Group to all Affiliates, employees, families and the community, in a professional manner as demonstrated by feedback from these sources. Participates in community activities such as health fairs as directed by Grant Coordinator.

• Educates other hospital staff concerning job role, community-base, entitlement programs, etc.

• Performs other duties as required. ​

REQUIRED QUALIFICATIONS

• NA

PREFERRED QUALIFICATIONS

• NA

EDUCATION:

LICENSES / CERTIFICATIONS:

PHYSICAL REQUIREMENTS:

Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67–100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver’s license.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$19.00 - $25.00

CITY:

Rochester

POSTAL CODE:

14621

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.

Rochester Regional Health is an integrated health services organization serving the people of Western New York, the Finger Lakes, St. Lawrence County, and beyond. The system includes nine hospitals; primary and specialty practices, rehabilitation centers, ambulatory campuses and immediate care facilities; innovative senior services, facilities and independent housing; a wide range of behavioral health services; and Rochester Regional Health Laboratories and ACM Global Laboratories, a global leader in patient and clinical trials. It’s vision is to lead the evolution of healthcare to enable every member of the communities it serves to enjoy a better, healthier life.