Referral Coordinator I
About The Position
It's more than a career, it's a calling. MO-SSM Health Medical Group St. Charles-1821 Sherman Drive Worker Type: Regular Job Highlights: Monday-Friday-8:00AM-4:30PM Healthcare experience preferred Patient oriented individual Location-SSM Health-Medical Group-St. Charles Join Our Team and make a difference every day while enjoying competitive pay, great benefits, and a supportive work environment. We offer competitive, affordable health insurance and benefits designed to support you and your family Fulfill your calling with SSM Health — apply today! 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
Nice To Haves
- Healthcare experience preferred
- Patient oriented individual
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.
- Explore All Benefits
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
