Referral Coordinator I

SSM Health; Missouri; Remote; USD 35,000 - 50,000; Full time

Benefits offered by this job

Paid Parental Leave

Flexible Payment Options

Upfront Tuition Coverage

Job summary

A healthcare provider is seeking a Referral Coordinator I to facilitate provider referrals, pre-certifications, and authorizations for managed care insurance plans. This full-time position requires a high school diploma or equivalent and involves coordinating with various stakeholders to ensure compliance with insurance requirements. The ideal candidate will demonstrate strong organizational and communication skills and be prepared for frequent engagement in a fast-paced environment.

Qualifications

• Ability to coordinate and process referrals efficiently.
• Strong communication skills to collaborate with insurance companies.
• Organizational skills to manage multiple referrals simultaneously.

Responsibilities

• Coordinates provider referrals and pre-authorizations.
• Verifies insurance coverage and creates price estimates.
• Collaborates with insurance and provider staff for optimal services.

Skills

Organizational skills

Communication skills

Education

High School diploma/GED

Job description

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Worker Type

Regular

Job Summary

Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.

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-authorizations 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

8411000125 Referral Coordinators

Scheduled Weekly Hours

40

Benefits

• Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
• Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
• Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.

Seniority Level

• Entry level

Employment Type

• Full-time

Job Function

• Health Care Provider

Industries

• Hospitals and Health Care