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!!

In this position you will be working with a team of independent and autonomous Referral Coordinators within the Intake Department to break down barrier and ensure quality and timely care. In collaboration with your teammates, you will strive for continuous improvement and an excellent work-life balance to product top-notch results.

WHAT YOU’LL BE DOING

• Interpreting referral and pre-certifications complying with multiple sets of protocols which are built in the application
• Maintaining and manages strict confidentiality of all information, whether received directly or indirectly as it relates to health care services
• Entering referral and pre-certification calls into software program accurately
• Answering phone calls as well as make phone calls
• Responsible for expediting calls to ensure accuracy and timeliness of referral and pre-certification authorizations
• Assisting physician offices and providers with referral and pre-certification questions
• Working with Customer Service, Provider Relations and Claims staff to clarify or rectify discrepancies between referrals, pre-certifications and claims
• Adhering to all audit procedures

WHAT YOU'LL NEED TO HAVE

• Knowledge of medical terminology
• Preferred medical office experience
• One years' experience in managed care with referral interpretation
• Knowledge of medical coding; including ICD-10, HCPC's and CPT codes
• Able to adapt to different situations and multitask
• Must have ability to work independently, maintain organization and meet deadlines
• Highly skilled in verbal and written communication
• Able to problem solve, exercise initiative and make decisions
• Able to communicate clearly and work effectively with co-workers, management, physicians, members, vendors and customers

WHAT WE WOULD LOVE FOR YOU TO HAVE

• Knowledge of Excel basic function and PDF Converter and/or Adobe Pro

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.