Referral Coordinator II

SSM Health; Jefferson City (MO); On-site; USD 35,000 - 55,000; Full time

Job summary

An established industry player seeks a dedicated individual to coordinate provider referrals and manage pre-authorizations for insurance plans. This role involves gathering clinical information, verifying insurance coverage, and ensuring that all necessary requirements are met before patient services. With a focus on maximizing reimbursement and providing excellent patient care, this position offers a chance to make a significant impact in a supportive environment. Join a team that values its employees and provides a comprehensive benefits package, including flexible payment options and tuition coverage.

Benefits

Paid Parental Leave

Flexible Payment Options

Upfront Tuition Coverage

Qualifications

• Coordinates referrals and pre-authorizations for managed care.
• Gathers clinical information and processes insurance requirements.

Responsibilities

• Attends in-services provided by various health plans.
• Logs and tracks managed care approvals and denials.
• Works collaboratively with insurance companies and providers.

Skills

Referral Coordination

Insurance Verification

Patient Scheduling

Communication Skills

Education

High School Diploma or GED

Job description

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

OK-SSM Health St. Anthony Hospital - Oklahoma City

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.
• 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

Work Shift:

Day Shift (United States of America)

Job Type:

Employee

Department:

7312020167 SAPO ORTH SPTS MED MT

Scheduled Weekly Hours:

40

Benefits:

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

• 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.

Explore All Benefits

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.