Referral Coordinator

SSM Health; Jefferson City (MO); On-site; USD 42,000 - 54,000; Full time

Job summary

SSM Health St. Mary's Hospital – Jefferson City is seeking a Regular full-time Referral Coordinator in the Sleep Disorders Lab.

You will coordinate provider referrals, pre-certifications, and pre-authorizations for managed care plans, while traveling to off-site locations as needed and ensuring timely, accurate communication with plans and providers. Responsibilities include logging and tracking approvals/denials, handling emergency referrals, verifying insurance benefits, preregistering and

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-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.
• Preregisters patients for appointments.
• Schedules patients for appointments appropriately.
• Performs all other duties as assigned.

Education

High School diploma/GED or 10 years of work experience

Job description

It's more than a career, it's a calling.

MO-SSM Health St. Mary's Hospital - Jefferson City

Worker Type

Regular

Job Highlights

• Department: Sleep Lab
• Schedule: Full Time, Days
• Location: Jefferson City, MO

Our mission and values put the patient first and helps you to feel valued while respecting teamwork and collaboration. Our Referral Coord roles are an integral piece in our care team and we see it as a partnership. At SSM Health, we know the healing power of presence begins with compassionate people like you.

Daily Pay

Get paid daily doing the work you love in a way that fits your life. At SSM Health, we believe you deserve the flexibility to work a schedule that fits your life and to get paid when you need it.

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.
• Preregisters patients for appointments.
• Schedules patients for appointments appropriately.
• Performs all other duties as assigned.

Education

• High School diploma/GED or 10 years of work experience

Experience

• One year experience required

Physical 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

3602000011 Sleep Disorders Lab

Work Shift

Day Shift (United States of America)

Scheduled Weekly Hours

40

Equal Opportunity Employer

SSM Health is an Equal Opportunity Employer. SSM Health provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, gender, pregnancy, sexual orientation, gender identity, national origin, age, disability, protected veteran status, genetic information, or any other characteristic protected by applicable federal, state, or local law.