Referral Coordinator II

Job Highlights

The Referral Coordinator II plays a vital role in supporting patient access and care coordination within a busy Cardiology specialty practice. This on-site position is scheduled Monday through Friday from 8:00 AM to 4:30 PM, offering a consistent weekday schedule with no weekends or holidays required.

Job Responsibilities and Requirements

• Attends in-services provided by various health plans.
• Travels to off-site locations as necessary.
• Gathers necessary clinical information and processes referrals, pre-certifications, pre-determinations, and pre-authorizations 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 creates 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.
• Serves as a point of contact for patients regarding their insurance coverage and benefits.
• Serves as a liaison between the patient, provider, and insurance company to resolve issues related to referrals, pre-certifications, and pre-authorizations.
• Serves as a resource for patients regarding insurance-related questions and concerns.
• Pre-registers patients for appointments.
• Schedules patients for appointments appropriately.
• Performs all other duties as assigned.

Education and Experience

One year experience required. High School diploma/GED or 10 years of work experience.

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.
• Able to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Rare climbing.

Department

Knight of Columbus Center

Work Shift

Day Shift

Scheduled Weekly Hours

40

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. Explore All Benefits

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.