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Worker Type:

PRN

Job Highlights:

This is a PRN (as needed) position filling in open shifts during the week. The hours would be 7:30am-4pm and will support all 6 Care Care Infusion Centers. The position will be remote after training period. There are no guaranteed hours or benefits.

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:

6888000125 Oncology Network

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

0

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 (https://jobs.ssmhealth.com/us/en/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. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?\_ga=2.205881493.704955970.1667719643-240470506.1667719643)_