It's more than a career, it's a calling.
MO-SSM Health Cardinal Glennon Children's HospitalWorker Type:
RegularJob Highlights:
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:
2071010010 Knights of Columbus ILWork Shift:
Day Shift (United States of America)Scheduled Weekly Hours:
40SSM Health is an Equal Opportunity Employer. SSM Health provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, gender, pregnancy, sexual orientation, gender identity, national origin, age, disability, protected veteran status, genetic information, or any other characteristic protected by applicable federal, state, or local law. Click here to learn more.
Skills Required
- High school diploma or GED, or 10 years of work experience
- No prior experience required
- Customer service experience
- Epic experience
- Scheduling experience
- Professional license or certification
SSM Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about SSM Health and has not been reviewed or approved by SSM Health.
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Healthcare Strength — Multiple medical plan options and pharmacy programs, including steep copay discounts at SSM Health Pharmacies and routine vaccines at no cost, are emphasized. These design elements indicate robust core coverage that can anchor overall value.
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Retirement Support — A 403(b)/401(k) with employer match plus a fixed annual employer contribution, auto-enrollment, and a year-end match true-up are featured. This structure provides clear support for long-term savings for eligible employees.
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Affordable Benefits — Income-based premium discounts, zero-cost prescriptions for qualifying households, and pharmacy copay reductions can lower out-of-pocket costs when using in-network resources. On-demand pay (DailyPay) also aids near-term affordability for eligible roles.
SSM Health Insights
What We Do
SSM Health is a Catholic, not-for-profit, fully integrated health system dedicated to advancing innovative, sustainable, and compassionate care for patients and communities throughout the Midwest and beyond. The organization serves comprehensive health needs through hospitals, physician offices, outpatient and virtual care services, comprehensive home care and hospice services, a fully transparent pharmacy benefit company, a health insurance company and an accountable care organization.
