Referral Coordinator II

SSM Health

1d • Onsite

About The Position

The Referral Coordinator II plays a vital role in supporting patient access and care coordination within a busy Cardiology specialty practice. This on-site position is scheduled Monday through Friday from 8:00 AM to 4:30 PM, offering a consistent weekday schedule with no weekends or holidays required.

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

• Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.
• 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 their earned, unpaid base pay (fees may apply) before payday
• 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