Referral Coordinator Ii Jobs

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

OK-SSM Health St. Anthony Hospital - Oklahoma City

Worker Type:

Regular

Job Summary:

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

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Responds in a timely manner to last minute/emergency referrals or additional codes performed during a procedure, or procedural changes for pre-authorizations.
• Logs, tracks and reviews managed care approvals and denials.
• Attends in-services provided by various health plans.
• Performs all other duties as assigned.
• Schedules patients for appointments appropriately.
• Preregisters patients for appointments.
• Travels to off-site locations as necessary.
• 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.
• Verifies insurance coverage, benefits and creatrs price estimates, reverifications as needed (ex; first of the month reverifications for managed Medicaid's).
• Gathers necessary clinical information and processes referrals, pre-certification, pre-determinations, and pre-authorizes according to insurance plan requirements.

EDUCATION

• High school diploma or equivalent

EXPERIENCE

• One year experience required

PHYSICAL REQUIREMENTS

• Frequent keyboard use/data entry.
• 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 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 hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

Work Shift:

Day Shift (United States of America)

Employee

Department:

6100000040 SAPO HEART and VASCULAR

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.