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Referral Coordinator l

SSM Health

Location Fond Du Lac, WI 54935
Department WI-St. Agnes Hospital
Posted 5 days ago -
Type: Full-Time Permanent
Reference ID: 11268979

Description

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 or equivalent

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.

This position works in the Emergency Department.  The position is every Saturday and Sunday from 7:00am-7:00pm. 

Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.

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