[Hiring] Intake Coordinator @Guidehealth

Role Description

The intake coordinator reviews and approves routine referrals and pre-certifications submitted while following established guidelines for our Blue Cross HMO.

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.
• Providing clerical support with computer entry, incoming and outgoing phone calls.
• Entering referrals and pre-certifications complying with multiple sets of protocols built in the application.
• Maintaining and managing strict confidentiality of all information related to health care services.
• Entering referrals and pre-certifications into software accurately using ICD-10 and CPT coding while following necessary guides to maintain compliance with delegation and state requirements.
• Answering phone calls as well as making phone calls.
• Accurately and timely reviewing referral and pre-certifications authorizations.
• Assisting physician offices and providers with referral and pre-certification questions.
• Working with Provider Relations and Claims staff to clarify or rectify discrepancies between referrals, pre-certifications, 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.

Qualifications

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

Requirements

• Understanding of medical coding (CPT and ICD-9).
• Advanced degrees, certifications, or additional experience that could enhance performance.

Benefits

• Work from Home: Guidehealth is a fully remote company, providing flexibility.
• Keep Health a Priority: Comprehensive Medical, Dental, and Vision plans.
• Plan for the Future: 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: Life and Disability insurance provided.
• Feel Supported When You Need It Most: Employee Assistance Program (EAP) available.
• Take Time for Yourself: Paid time off plans offered.
• Support Your New Family: Paid parental leave available.
• Learn and Grow: Resources dedicated to your learning and development.