November 16, 2024

SSM Health

FULL TIME

Referral Coordinator I

It's more than a career, it's a calling.
MO-REMOTE
Worker Type:
Regular
Job Highlights:

Department: SLUCare Centralized Contact Ctr
Schedule: Full Time, Day Shift (Mon-Fri 8:00am-5:00pm) No Nights/Weekends/Holidays
Starting Pay: $16.41 (Offers are based on years of experience and equity for this role.)
Experience: Referrals, pre-certifications, and pre-authorizations
Shift Differentials: Available for evening, night, weekend, and additional shifts
Location: Integrated Health Technologies Center 7980 Clayton Rd

Position will be with the SLUCare Physician Group. Candidates must be located within the St. Louis metro area. The first 3-4 months of employment will be on-site in St. Louis. After a successful training period, employees are permitted to work from home.

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

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.

Department:
8565000235 SLUCare Centralized Contact Ctr
Work Shift:
Day Shift (United States of America)
Scheduled Weekly Hours:
40
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.

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 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.