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MO-SSM Health St. Mary's Hospital - Jefferson City

Worker Type:

Regular

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

Work Shift:

Day Shift (United States of America)

Job Type:

Employee

Department:

2104000163 Clinic Network

Scheduled Weekly Hours:

36

_SSM Health is an Equal Opportunity Employer. SSM Health provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, gender, pregnancy, sexual orientation, gender identity, national origin, age, disability, protected veteran status, genetic information, or any other characteristic protected by applicable federal, state, or local law._ Read our notice of non-discrimination (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?\_ga=2.205881493.704955970.1667719643-240470506.1667719643)

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