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Worker Type:

Regular

Job Summary:

Are you ready to play a critical role in ensuring timely, high-quality patient care from behind the scenes? As a Referral Coordinator, you’ll be the vital link between patients, providers, and payers—driving the authorization process that keeps surgical procedures on track and revenue flowing. From verifying insurance and securing urgent approvals to collaborating with doctors’ offices and navigating complex payer requirements, your expertise ensures no patient is left waiting. Without you, delays in care, canceled appointments, and lost revenue become a reality. With you, we deliver seamless care, maximize reimbursement, and elevate patient satisfaction. Join us and be the difference that keeps healthcare moving forward.

**Occasional travel to the St. Louis. MO corporate office is required.

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.

+ Performs all other duties as assigned.

EDUCATION

+ High School diploma/GED or 10 years of work experience

EXPERIENCE

+ No 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

Work Shift:

Day Shift (United States of America)

Job Type:

Employee

Department:

8701390033 Pre-Service

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 (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)_