Referral Coordinator - Wound Center

SSM Health • Saint Louis, MO

1d • Onsite

About The Position

This is a full-time, day-shift position working Mon-Fri from 7am-3:30pm. The Referral Coordinator is responsible for coordinating provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans. The role requires good customer service skills and preferred experience with EPIC, referrals, and authorizations.

Requirements

• High School diploma/GED or 10 years of work experience
• One year experience required
• Good customer service skills
• EPIC experience preferred
• Experience with referrals and authorizations preferred

Nice To Haves

• EPIC experience
• Experience with referrals and authorizations

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