Remote Referral Coordinator - Managed Care

SSM Health; Oklahoma; Hybrid; USD 38,000 - 52,000; Full time

Job summary

SSM Health coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans. The role involves supporting scheduling and ensuring plan requirements are met before services are rendered.

Responsibilities include attending plan in-services, traveling to off-site locations, verifying coverage, and tracking approvals and denials to maximize reimbursement, while collaborating with providers and staff.

Qualifications

• High School diploma/GED or 10 years of work experience.
• No experience required.
• Travels to off-site locations as necessary.

Responsibilities

• Attends in-services provided by various health plans.
• Travels to off-site locations as necessary.
• Gathers clinical information and processes referrals, pre-certifications, pre-determinations, and pre-authorizations.
• 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; creates price estimates and reverifications as needed.
• Works with insurers, providers and staff to meet plan requirements before patient services.
• Performs all other duties as assigned.

Education

High School diploma/GED or 10 years of work experience

Job description

SSM Health coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans. The role involves supporting scheduling and ensuring plan requirements are met before services are rendered.

Responsibilities include attending plan in-services, traveling to off-site locations, verifying coverage, and tracking approvals and denials to maximize reimbursement, while collaborating with providers and staff.