Referral Coordinator II

SSM Health • Jefferson City, MO

1d • Onsite

About The Position

Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans. This role is more than a career, it's a calling. The Referral Coordinator II attends in-services provided by various health plans and travels to off-site locations as necessary. They gather necessary clinical information and process referrals, pre-certification, pre-determinations, and pre-authorizations according to insurance plan requirements. The role involves logging, tracking, and reviewing managed care approvals and denials, and responding in a timely manner to last minute/emergency referrals or additional codes performed during a procedure, or procedural changes for pre-authorizations. Additionally, the Referral Coordinator II verifies insurance coverage, benefits, creates price estimates, and performs reverifications as needed. They work collaboratively with insurance companies, providers, and staff to ensure plan requirements are met prior to patient services being rendered to maximize reimbursement. The role also includes preregistering and scheduling patients for appointments.

Requirements

• High School diploma/GED or 10 years of work experience
• One year 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.

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.
• Preregisters patients for appointments.
• Schedules patients for appointments appropriately.
• Performs all other duties as assigned.

Benefits

• One week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
• Instant access to earned, unpaid base pay before payday through DailyPay (fees may apply).
• Upfront tuition coverage through FlexPath Funded for eligible team members.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees