Referral Coordinator Jobs

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

OK-SSM Health Medical Group Shawnee

Worker Type:

Regular

Job Summary:

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

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• 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.
• Attends in-services provided by various health plans.
• Preregisters patients for appointments.
• Performs all other duties as assigned.
• Travels to off-site locations as necessary.
• 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).
• Schedules patients for appointments appropriately.
• 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.

EDUCATION

• High school diploma or equivalent

EXPERIENCE

• One year experience required

PHYSICAL REQUIREMENTS

• 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.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Rare climbing.
• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.

Work Shift:

Day Shift (United States of America)

Employee

Department:

2482990024 Conversion

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.