Referral Coordinator

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

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

MO-SSM Health Cardinal Glennon Children's Hospital

Worker Type:

Regular

Job Highlights:

This is a full-time position, Monday through Friday, from 8:00 AM to 4:30 PM. Experience in customer service, Epic, and scheudling 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 experience

Experience

• No 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:

2071010010 Knights of Columbus IL

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

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.