It's more than a career, it's a calling.

MO-SSM Health Cardinal Glennon Children's Hospital

Worker Type:

Regular

Job Highlights:

Department: Developmental PediatricsSchedule: Full-Time, Day ShiftStarting Pay: $16.41+/hr (Offers are based on years of experience and equity for this role.)Shift Differentials: Available for evening, night, weekend, and additional shiftsLocation: MO-SSM Health Cardinal Glennon Children's Hospital

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 experience

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.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS 

None

Department:

2071000010 Knight of Columbus Center

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.