Referral Coordinator II

SSM Health; Missouri; On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Paid parental leave

DailyPay flexible payment options

Tuition coverage via FlexPath

Job summary

SSM Health is seeking a Referral Coordinator to manage provider referrals, pre-certifications, and pre-authorizations for managed care plans. This full-time, day-shift role involves coordinating with health plans, providers, and staff to ensure timely and accurate pre-authorization processes.

Qualifications include a High School diploma or GED and at least one year of referral coordination experience. Occasional travel to off-site locations may be required.

Qualifications

• High School diploma or GED or equivalent work experience.
• One year of experience in referral coordination or related role.
• Ability to travel to off-site locations.
• Excellent communication and organizational skills.
• Experience with managed care or insurance processes is a plus.

Responsibilities

• Attends in-services provided by various health plans.
• Travels to off-site locations as necessary.
• Gathers clinical information and processes referrals, pre-certifications, and pre-authorizations.
• Logs, tracks and reviews managed care approvals and denials.
• Responds promptly to urgent referrals or changes for pre-authorizations.
• Verifies coverage and benefits and creates price estimates; reverifications as needed.
• Coordinates with insurers, providers and staff to meet plan requirements before services.
• Preregisters patients for appointments.
• Schedules patients for appointments appropriately.
• Performs all other duties as assigned.

Skills

Referral coordination

Pre-authorizations

Managed care

Insurance billing

Education

High School diploma/GED

Job description

It's more than a career, it's a calling. MO-SSM Health SLUCare Academic Pavilion

Worker Type: Regular

Job Highlights

This is a full-time, day-shift position working Monday-Friday from 7:30-4:00PM. The role requires one of referral coordianor experience.

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:

4940000235 Orthopaedic Surgery Gen - Admin

Work Shift:

Day Shift (United States of America)

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.