Referral Coordinator

SSM Health; Oklahoma; Hybrid; USD 38,000 - 52,000; Full time

Job summary

SSM Health coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans. The role involves supporting scheduling and ensuring plan requirements are met before services are rendered.

Responsibilities include attending plan in-services, traveling to off-site locations, verifying coverage, and tracking approvals and denials to maximize reimbursement, while collaborating with providers and staff.

Qualifications

• High School diploma/GED or 10 years of work experience.
• No experience required.
• Travels to off-site locations as necessary.

Responsibilities

• Attends in-services provided by various health plans.
• Travels to off-site locations as necessary.
• Gathers clinical information and processes referrals, pre-certifications, pre-determinations, and pre-authorizations.
• Logs, tracks and reviews managed care approvals and denials.
• Responds promptly to last-minute referrals or changes for pre-authorizations.
• Verifies insurance coverage and benefits; creates price estimates and reverifications as needed.
• Works with insurers, providers and staff to meet plan requirements before patient services.
• 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.

OK-REMOTE

Worker Type:

Regular

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

Work Shift:

Day Shift (United States of America)

Job Type:

Employee

Department:

8073000040 Centralized Scheduling

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. Read our notice of non-discrimination (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?_ga=2.205881493.704955970.1667719643-240470506.1667719643)