**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 Pediatrics + Schedule: Full-Time, Day Shift + Starting 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 shifts + Location: 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. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?\_ga=2.205881493.704955970.1667719643-240470506.1667719643)_