Remote Referral & Pre-Auth Coordinator

SSM Health; Missouri; Hybrid; USD 21,000 - 30,000; Full time

Job summary

SSM Health in Missouri is seeking a Centralized Contact Center coordinator to manage referrals, pre-certifications, and pre-authorizations for managed care plans. This role involves coordinating between providers, plans, and patients to ensure timely processing and compliance, with regular reviews of approvals and denials.

Initial training is onsite for 3-4 months, then remote work is possible. Schedule is Monday to Friday, 8am to 4:30pm, with a requirement to live within an hour of the site due

Qualifications

• High School diploma/GED or 10 years of work experience.
• No experience required.

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 reverifications as needed.
• 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.

Skills

Attention to detail

Compassion

Team collaboration

Education

High School diploma/GED

10 years of work experience

Job description

SSM Health in Missouri is seeking a Centralized Contact Center coordinator to manage referrals, pre-certifications, and pre-authorizations for managed care plans. This role involves coordinating between providers, plans, and patients to ensure timely processing and compliance, with regular reviews of approvals and denials.

Initial training is onsite for 3-4 months, then remote work is possible. Schedule is Monday to Friday, 8am to 4:30pm, with a requirement to live within an hour of the site due