Referral Coordinator I

SSM Health • Clayton, MO

8d • Onsite

About The Position

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

Requirements

• High School diploma/GED or 10 years of work experience
• Prior authorization and referral preferred
• Medical Terminology & Insurance knowledge

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 creates 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

• Competitive pay
• Great benefits
• Supportive work environment
• Competitive, affordable health insurance
• Paid Parental Leave: one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
• Flexible Payment Options: instant access to earned, unpaid base pay before payday (fees may apply).
• 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