Referral & Authorization Specialist

SSM Health; Jefferson City (MO); On-site; USD 36,000 - 60,000; Full time

Job summary

SSM Health St. Mary’s Hospital – Jefferson City is seeking a Regular, full-time Coordinator to manage referrals, pre-certifications, and pre-authorizations for managed care plans. The role requires at least 1 year of experience and a high school diploma or equivalent.

Responsibilities include processing referrals, tracking approvals, and ensuring plan requirements are met before patient services. Occasional travel to off-site locations is expected; day shift with standard hours.

Qualifications

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

Responsibilities

• Attends in-services provided by various health plans.
• Travels to off-site locations as necessary.
• Gathers necessary clinical information and processes referrals, pre-certifications, pre-determinations, and pre-authorizations.
• Logs, tracks and reviews managed care approvals and denials.
• Responds in a timely manner to last minute/emergency referrals or changes for pre-authorizations.
• Verifies insurance coverage, benefits and reverifications as needed.
• Works collaboratively with insurance companies, providers and staff to ensure plan requirements are met prior to patient services.
• Preregisters patients for appointments.
• Schedules patients for appointments.
• Performs all other duties as assigned.

Skills

Referral coordination

Pre-authorizations

Customer service

Education

High School diploma / GED

Tools

EMR / Computer literacy

Job description

SSM Health St. Mary’s Hospital – Jefferson City is seeking a Regular, full-time Coordinator to manage referrals, pre-certifications, and pre-authorizations for managed care plans. The role requires at least 1 year of experience and a high school diploma or equivalent.

Responsibilities include processing referrals, tracking approvals, and ensuring plan requirements are met before patient services. Occasional travel to off-site locations is expected; day shift with standard hours.