Referral Coordinator I

SSM Health

1d • Onsite

About The Position

It's more than a career, it's a calling. MO-REMOTE Worker Type: Regular Job Highlights: This role is scheduled Monday - Friday. Referral Coordinators begin with 90 days of onsite training at the 7980 Clayton Rd location. Past experience in a medical office/coordinating referrals is preferred. Job Summary: Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.

Requirements

• High School diploma/GED or 10 years of work experience
• No experience required
• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication.
• Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.
• None REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS

Nice To Haves

• Past experience in a medical office/coordinating referrals is preferred.

Responsibilities

• Attends in-services provided by various health plans.
• Travels to off-site locations as necessary.
• Gathers necessary clinical information and processes referrals, pre-certification, pre-determinations, and pre-authorizes according to insurance plan requirements.
• Logs, tracks and reviews managed care approvals and denials.
• Responds in a timely manner to last minute/emergency referrals or additional codes performed during a procedure, or procedural changes for pre-authorizations.
• Verifies insurance coverage, benefits and creatrs price estimates, reverifications as needed (ex; first of the month reverifications for managed Medicaid's).
• Works collaboratively with insurance companies, providers and staff to ensure plan requirements have been met prior to patient services being rendered in order to maximize reimbursement.
• Performs all other duties as assigned.

Benefits

• SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
• Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
• Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
• Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED