Referral Coordinator I

Job description

It's more than a career, it's a calling. MO-REMOTE 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. - Performs all other duties as assigned. EDUCATION: - High School diploma/GED or 10 years of work exp...