Remote Referral & Authorization Specialist

SSM Health; Oklahoma; Remote; USD 45,000 - 60,000; Full time

Job summary

SSM Health is seeking a Remote Scheduling Coordinator to manage provider referrals and pre-certifications for managed care insurance plans. This role involves coordinating with plans, clinicians, and staff to ensure timely pre-authorizations before patient services.

You will travel to off-site locations as needed, handle inquiries, verify details, and maintain accurate records to maximize reimbursement and compliance with plan requirements.

Qualifications

• High School diploma/GED or 10 years of work experience.

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

Job description

SSM Health is seeking a Remote Scheduling Coordinator to manage provider referrals and pre-certifications for managed care insurance plans. This role involves coordinating with plans, clinicians, and staff to ensure timely pre-authorizations before patient services.

You will travel to off-site locations as needed, handle inquiries, verify details, and maintain accurate records to maximize reimbursement and compliance with plan requirements.