Referral & Authorization Specialist

SSM Health; Missouri; On-site; USD 36,000 - 48,000; Full time

Job summary

SSM Health Cardinal Glennon Children's Hospital in Missouri is seeking a dedicated team member to coordinate provider referrals, pre-certifications, and pre-authorizations for managed care plans. This full-time role runs Monday through Friday, 8:00 AM to 4:30 PM, totaling 40 hours per week.

The position emphasizes collaboration with insurers and healthcare providers to ensure timely, compliant approvals and optimal reimbursement.

Qualifications

• High School diploma or GED, or 10 years of work experience.
• Customer service experience in a healthcare setting preferred.
• Epic experience and scheduling skills are preferred.

Responsibilities

• Attends in-services provided by health plans.
• Travels to off-site locations as necessary.
• Gathers clinical information and processes referrals, pre-certifications, pre-determinations, and pre-authorizations per plan requirements.
• Logs, tracks and reviews managed care approvals and denials.
• Responds promptly to last minute or emergency referrals and changes for pre-authorizations.
• Verifies insurance coverage, benefits and price estimates; performs reverifications as needed.
• Collaborates with insurance companies, providers and staff to ensure plan requirements are met for reimbursement.
• Performs all other duties as assigned.

Skills

Customer service

Epic

Scheduling

Education

High School diploma/GED or 10 years of work experience

Job description

SSM Health Cardinal Glennon Children's Hospital in Missouri is seeking a dedicated team member to coordinate provider referrals, pre-certifications, and pre-authorizations for managed care plans. This full-time role runs Monday through Friday, 8:00 AM to 4:30 PM, totaling 40 hours per week.

The position emphasizes collaboration with insurers and healthcare providers to ensure timely, compliant approvals and optimal reimbursement.