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SSM Health Care - Richmond Heights, MO
posted 2 months ago
About the position
The Referral Coordinator I position at SSM Health is a full-time role responsible for coordinating provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans. This position supports six departments and ensures timely patient check-ins and accurate insurance referrals for specialty providers. The role involves collaboration with insurance companies and healthcare providers to maximize reimbursement and streamline patient services.
Responsibilities
- Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.
- Attends in-services provided by various health plans.
- 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 creates price estimates, reverifications as needed.
- Works collaboratively with insurance companies, providers, and staff to ensure plan requirements have been met prior to patient services being rendered.
- Performs all other duties as assigned.
Requirements
- High school diploma or equivalent.
- No experience required.
Benefits
- Health insurance
- Paid parental leave
- Flexible Payment Options
- Upfront Tuition Coverage
