Referral Coordinator - Physical Medicine

It's more than a career, it's a calling.
IL-SSM Health Good Samaritan Hospital - Mt. Vernon
Worker Type:
Regular
Job Highlights:
Come join the therapy team at SSM Southern Illinois!
Work Mon-Fri day shift, no holidays or weekends - 8am-4:30pm. The office is located in the Physical Medicine department of Good Samaritan in Mt. Vernon, Illinois.
You will be verifying benefits and performing insurance authorizations for patients receiving physical therapy, occupational therapy and speech therapy for both our hospitals and outpatient locations. There will also be some work assisting the front office staff with scheduling, phone calls and daily duties such as managing work queues and denials and contacting physician offices.
Must have exceptional customer service, knowledge of medical terminology and be proficient with computers. This is a fast-paced environment with multiple patient interactions. If this sounds like a good fit for you - apply now!
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 or equivalent

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.

Department:
4509000046 Rehab Administration
Work Shift:
Day Shift (United States of America)
Scheduled Weekly Hours:
40
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.