Job detail

Referral Coordinator II

SSM Health

#Data Entry #Problem Solving #Communication #Managed Care #Medicaid #Insurance Verification #Health Plans #Reimbursement #Patient Scheduling

Quick overview

The Referral Coordinator II is responsible for coordinating provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans. This includes gathering clinical information, processing referrals, and ensuring compliance with insurance plan requirements.

Requirements summary

A high school diploma or GED is required, along with one year of relevant experience. The role also involves physical requirements such as frequent lifting and data entry.

high schoolCommunicationProblem SolvingData EntryInsurance VerificationPatient SchedulingReferral CoordinationManaged CareClinical Information GatheringPre-AuthorizationPre-Certification

Job description

It's more than a career, it's a calling.
MO-SSM Health St.
Clare Hospital - Fenton Worker Type: Regular Job Summary: Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.
Job Responsibilities and Requirements: PRIMARY 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.
Preregisters patients for appointments.
Schedules patients for appointments appropriately.
Performs all other duties as assigned.
EDUCATION High School diploma/GED or 10 years of work experience EXPERIENCE One year experience required PHYSICAL REQUIREMENTS 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.
REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS None Work Shift: Day Shift (United States of America) Job Type: Employee Department: 4979220235 SLUCare Surgery CSM Pod Scheduled Weekly Hours: 40 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.
Explore All Benefits SSM Health is an equal opportunity employer.
SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law.
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Referral Coordinator II

Quick overview

Requirements summary

Job description

Benefits

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