at SSM Health St. Mary's Hospital in Mt. Vernon, Illinois, United States
Job Description
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.
