Referral Coordinator - Knights of Columbus

JOB DESCRIPTION

It's more than a career, it's a calling.

MO-SSM Health Cardinal Glennon Children's Hospital

Worker Type : Job Summary :

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.
• 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

Work Shift :

Day Shift (United States of America)

Job Type : Employee

Employee

Department :

Knight of Columbus Center

Scheduled Weekly Hours :

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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