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SSM Health Referral Coordinator I in Saint Louis, Missouri

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.

SSM Health is committed to equal employment opportunity based on race, color, religion, national origin, gender, sexual orientation, gender identity, pregnancy, age, physical or mental disability, veteran status, and all other statuses protected by law.

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