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St. Jude Children's Research Hospital Coordinator-Referral & Defense Audits in Memphis, Tennessee

At St. Jude Children's Research Hospital no one pays for treatment beyond what is covered by insurance and those without insurance are never asked to pay. The nurses in the Utilization Review department ascertain insurance coverage and by providing clinical information they attempt to obtain reimbursement from third party payors when benefits are available. This assists St. Jude Children's Research Hospital to continue its mission to care for children with catastrophic diseases and to continue research to find cures and improve treatments for children worldwide.

Key Responsibilities for the role of the Referrals and Defense Audits Coordinator will be:

  • Obtains all referrals from primary care physicians for patients whose insurances require a referral number

  • Conducts defense audits for insurance payors prior to auditor visits

  • Assists the Utilization Review Coordinators with obtaining medical records and making authorization requests as needed

  • Maintains confidentiality of all information related to patients, medical staff, employees and St. Jude Children's Research Hospital

  • Graduate of an accredited Practical Nursing or Medical Assistant program.

  • Two (2) years related medical experience required.

  • Six (6) months of experience in a hospital environment required.

  • Clinical experience with referrals and authorizations is preferred.

  • Utilization review experience preferred.

  • (NL) Licensed Practical Nurse, State of Tennessee preferred.

COVID-19 vaccine:

As of September 10, 2021, St. Jude Children’s Research Hospital has mandated the COVID-19 vaccine for all employees, excluding those with an approved medical or religious accommodation, as a condition of employment.

EEO Statement: St. Jude is an Equal Opportunity Employer

No Search Firms:St. Jude Children's Research Hospital does not accept unsolicited assistance from search firms for employment opportunities. Please do not call or email. All resumes submitted by search firms to any employee or other representative at St. Jude via email, the internet or in any form and/or method without a valid written search agreement in place and approved by HR will result in no fee being paid in the event the candidate is hired by St. Jude.

Posted Job Title: Coordinator-Referral & Defense Audits

WITS Req ID: 46558

Street: 262 Danny Thomas Place