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Referral Coordinator II

4 months ago

Oklahoma City, Oklahoma, United States SSM Health Full time

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

OK-SSM Health Medical Group Administration Office

Worker Type:

Regular

Job Highlights:

Department: Orthopedic Clinic

Sign On Bonus: $2000

Schedule: Monday - Friday 8am -5pm

Location: 777 NW 63rd, Oklahoma City

**Sign on bonuses are for external qualified candidates. Internal candidates, please check with your recruiter to see what options are available for you. There is a required two-year service commitment to receive the sign on bonus.

Looking for an opportunity where patients come first, and you are valued as a team member? You will be a vital member of the care team for our patients. At SSM Health, we know the healing power of presence begins with compassionate people like you.

Get paid daily doing the work you love in a way that fits your life. At SSM Health St Anthony, we believe you deserve the flexibility to get paid when you need it. That's why we're offering DailyPay. Ask your recruiter for more details.

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

Department:

SAPO ORTH SPTS MED MT

Work Shift:

Day Shift (United States of America)

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. )