Referral Coordinator I - Saint Louis - SSM Health

    SSM Health
    SSM Health Saint Louis

    2 days ago

    Description

    It's more than a career, it's a calling
    MO-REMOTE
    Worker Type:

    Regular
    Job Highlights:This role is scheduled Monday
    • Friday.
    Referral Coordinators begin with 90 days of onsite training at the 7980 Clayton Rd location.
    Past experience in a medical office/coordinating referrals is preferred.


    Job Summary:

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


    Job Responsibilities and Requirements:

    PRIMARY 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.

    EDUCATION+ High School diploma/GED or 10 years of work experienceEXPERIENCE+ No experience requiredPHYSICAL REQUIREMENTS+ 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.

    REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS+ None
    Department: Referral Coordinators
    Work Shift:Day Shift (United States of America)

    Scheduled Weekly Hours:    40
    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 )_SSM Health is an equal opportunity employer.

    SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity,_ _pregnancy, veteran status_
    _,_ _or any other characteristic protected by applicable law.

    Click here to learn more. \_ga= _

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