Referral Coordinator I

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Referral Coordinator I

role at

SSM Health .

Its more than a career, its a calling.

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Worker Type
Regular

Job Summary
Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.

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-authorizations 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 Medicaids).

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.

Education

High School diploma/GED or 10 years of work experience

Experience

No 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
8411000125 Referral Coordinators

Scheduled Weekly Hours
40

Benefits

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.

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. Click here to learn more.

Seniority Level

Entry level

Employment Type

Full-time

Job Function

Health Care Provider

Industries

Hospitals and Health Care

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