Referral Coordinator

🔥 3 minutes ago

🏈 Alabama, Florida, +16 more states – Remote

🏈 Alabama – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🍑 Georgia – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

👻 Ghost score 10%

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SSM Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1872

🏥 Healthcare

🤝 Non-profit

💰 Grant on 2023-12

Healthcare • Non-profit

SSM Health is a Catholic, not-for-profit health system serving communities across the U. S. Midwest through an integrated network of hospitals, clinics, and care services. With locations in Illinois, Missouri, Oklahoma, and Wisconsin, SSM Health operates acute-care and specialty services (including teaching hospitals and level‑one trauma centers), emphasizes mission-driven, compassionate care, workforce development, and employee benefits, and supports flexible nursing and other clinical roles.

📋 Description

• Coordinate provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans • Attend in-services provided by various health plans • Travel to off-site locations as necessary • Gather clinical information and process referrals, pre-certifications, pre-determinations, and pre-authorizations according to insurance plan requirements • Log, track, and review managed care approvals and denials • Respond promptly to last-minute or emergency referrals, additional procedure codes, and procedural changes for pre-authorizations • Verify insurance coverage and benefits • Create price estimates and perform reverifications as needed, including first-of-the-month reverifications for managed Medicaid plans • Collaborate with insurance companies, providers, and staff to ensure plan requirements are met before patient services are rendered and maximize reimbursement • Attend to other duties as assigned

🎯 Requirements

• Preferred candidate location within Missouri • Must live in one of: Alabama, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah, West Virginia, or Wisconsin • Registration background preferred • EPIC knowledge preferred • Medical terminology preferred but not required • High School diploma/GED or 10 years of work experience • No experience required • Frequent keyboard use/data entry • Ability to perform listed physical activities, including lifting/carrying, pushing/pulling, sitting, standing, walking, reaching, repetitive movements, bending, stooping, kneeling, squatting, twisting, gripping, and rare climbing • Ability to use vision and depth perception for near and far distances and distinguish colors • Ability to use hearing and speech for oral communication and hear alarms and malfunctioning machinery • No professional license or certification required

🏖️ Benefits

• Fully remote work arrangement • Monday through Friday, 8:00 a.m. to 4:30 p.m. schedule • No weekend or on-call requirements • Regular employment status • Equal employment opportunities

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