Referral Coordinator - Wound Center

SSM Health; St. Louis (MO); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Paid Parental Leave

Flexible Payment Options (DailyPay)

Upfront Tuition Coverage

Job summary

SSM Health DePaul Hospital - St. Louis is seeking a Referral Coordinator to manage provider referrals, pre-certifications, and pre-authorizations for managed care plans.

This full-time, day-shift role requires EPIC experience, strong customer service skills, and the ability to travel to off-site locations when needed. You will preregister and schedule patients and support planned care workflows.

Qualifications

• High School diploma or GED required, or 10 years of related work experience.
• Minimum 1 year of experience in a similar role.
• EPIC experience and referrals/authorizations experience preferred.
• Strong customer service skills required.

Responsibilities

• Attends in-services provided by health plans.
• Travels to off-site locations as necessary.
• Gathers clinical information and processes referrals, pre-certification, pre-determinations, and pre-authorizations per plan rules.
• 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; supports pricing estimates as needed.
• Preregister and schedule patients for appointments; perform other duties as assigned.

Skills

Customer service

Education

High School diploma/GED

10 years of work experience

1 year of experience in related role

Tools

EPIC software

Job description

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

MO-SSM Health DePaul Hospital - St. Louis

Worker Type:

Regular

Job Highlights:

This is a full-time, day-shift position working Mon-Fri from 7am-3:30pm.

EPIC experience, and experience with referrals and authorizations is highly preferred. Must also have good customer service skills.

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:

2058010128 Wound Center

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.