Referral Coordinator II

Its more than a career its a calling.

Worker Type:

Job Highlights:

Job Summary:

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 Medicaids).
• 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:

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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.

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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.