Intake Referral Coordinator

WHO IS GUIDEHEALTH?

At Guidehealth, our mission is to enhance healthcare affordability for patients and restore the fulfillment of practicing medicine for providers. As a physician-led company, we recognize that streamlining administrative tasks and harnessing the power of predictive analytics and AI enable our partner physician practices prioritizing delivering high-quality healthcare focused on outcomes and value.

Driven by empathy, we empower physicians to anticipate the needs of patients requiring more attention, strengthen connections between patients and physicians with virtually-embedded Healthguides, and leverage AI and analytics to proactively avoid preventable events. This approach results in increased levels of patient and practice engagement, ultimately leading to more significant positive impacts on patients.

Join us as we put healthcare on a better path!!

As an intake coordinator you will be working with our provider partner, Blue Cross HMO, reviewing and authorizing referrals.

WHAT YOU’LL BE DOING

• Initiating pre-review screening on complex referrals and/or pre-certifications and submitting to the Clinical Services Department for review and finalization. Screens potential denials and submits to the Clinical Services Department.
• Providing clerical support with computer entry, in-coming and out-going phone calls.
• Entering of referral and pre-certifications complying with multiple sets of protocols which are built in the application.
• Maintaining and managing strict confidentiality of all information, whether received directly or indirectly as it relates to health care services.
• Entering referrals and precertification’s into software program accurately using ICD-10 and CPT coding as well as follow necessary guides to maintain compliance with delegation and state requirements.
• Answering phone calls as well as making phone calls.
• Accurately and timely review of referral and pre-certifications authorizations.
• Assisting physician offices and providers with referral and precertification questions.
• Working with Provider Relations and Claims staff to clarify or rectify discrepancies between referrals, precertification’s and claims.
• Assisting the Clinical Services Department nursing staff in the development and maintenance of internal referral manuals.
• Adhering to all audit procedures.
• Performing other duties as assigned.

WHAT YOU'LL NEED TO HAVE

• Prior experience in a healthcare setting working with referrals.
• Strong knowledge of HMO
• Knowledge of Excel basic function and PDF Converter and/or Adobe Pro
• Must be organized and task oriented
• Strong time management skills
• Ability to work independently

WHAT WE WOULD LOVE FOR YOU TO HAVE

• Understanding of medical coding (CPT and ICD)

COMPENSATION

Guidehealth’s compensation structure includes more than just base salary. We believe in providing world-class benefits including comprehensive medical, dental, and vision plans, long and short-term disability, life insurance, and a 401k plan with a generous match. Our paid time off program includes paid holidays and flexible time that focuses on meeting the demands of the position and our clients, while providing the balance that our employees need.

The base pay range for this role is between $18.00 to $20.00 per hour, paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.

This position is responsible for following all Security policies and procedures in order to protect all PHI under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.