Insurance Navigator MTV - Dix - job 958070

SSM Health

Date: 07/22/2021

City: Dix, Illinois

Employment type: Full-time

Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.


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 or equivalent


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.




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