Referral Coordinator

This is a fully remote position, open to applicants in Alabama, +17 more locations.

📋 Description

• Coordinate referrals, pre-certifications, and pre-authorizations for managed care insurance plans.

• Attend in-service training sessions offered by various health plans.

• Travel to off-site locations as required.

• Collect clinical information and manage referrals, pre-certifications, pre-determinations, and pre-authorizations in accordance with insurance plan guidelines.

• Log, monitor, and evaluate managed care approvals and denials.

• Respond swiftly to urgent or last-minute referrals, additional procedure codes, and changes to procedures for pre-authorizations.

• Verify insurance coverage and benefits.

• Generate price estimates and conduct reverifications as necessary, including monthly reverifications for managed Medicaid plans.

• Collaborate with insurance companies, healthcare providers, and internal staff to ensure compliance with plan requirements prior to the delivery of patient services and to maximize reimbursement.

• Attend to additional responsibilities as assigned.

⛳️ Requirements

• Preferred candidate location is within Missouri.

• Must reside in one of the following states: Alabama, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah, West Virginia, or Wisconsin.

• Background in registration is preferred.

• Familiarity with EPIC is preferred.

• Knowledge of medical terminology is preferred but not mandatory.

• High School diploma/GED or 10 years of relevant work experience.

• No prior experience is required.

• Frequent use of a keyboard and data entry is expected.

• Ability to perform specified physical tasks, including lifting/carrying, pushing/pulling, sitting, standing, walking, reaching, repetitive movements, bending, stooping, kneeling, squatting, twisting, gripping, and occasional climbing.

• Capability to use vision and depth perception for both near and far distances and to distinguish colors.

• Ability to use hearing and speech for verbal communication and to hear alarms and malfunctioning equipment.

• No professional license or certification is required.

🏝️ Benefits

• Fully remote work arrangement.

• Monday through Friday schedule from 8:00 a.m. to 4:30 p.m.

• No weekend or on-call duties.

• Regular employment status.

• Equal employment opportunities.