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

MO-SSM Health St. Clare Hospital - Fenton

**Worker Type:**

Regular

**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 mo...