Referral Coordinator I

Job Summary: Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.

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-authorizations 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 Experience No 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 Work Shift Day Shift (United States of America) Job Type Employee Department 8411000125 Referral Coordinators Scheduled Weekly Hours 40

Benefits: 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 Daily Pay 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 Flex Path Funded for eligible team members. 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. Seniority Level Entry level Employment Type Full-time Job Function Health Care Provider Industries Hospitals and Health Care