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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. 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 FOR SUCCESS
Prior experience in a healthcare setting.
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 WOULD LOVE FOR YOU TO HAVE Understanding of medical coding (CPT and ICD-9) Advanced degrees, certifications, or additional experience that could enhance performance.
The hourly range for this role is $20 - $21 per hour based upon skills and experience.
ALIVE with Purpose: How We Thrive at Guidehealth At Guidehealth , our values come to life in everything we do.
We are Driven by A ccountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.
Always Growing, Always L earning — staying curious and continuously improving inspires us to shape a better future for healthcare.
With Collaborative I nnovation, we solve problems creatively, making every experience better for our employees and the patients we serve.
At Guidehealth , Every V oice Matters — we believe our collective strength is rooted in the unique perspectives of each team member.
And through E mpathy in Action, we build stronger connections with those who count on us.
This is what it means to be ALIVE with purpose. This is how we thrive — together — at Guidehealth .
BENEFITS:
While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:
Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.
All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.
COMPENSATION:
The listed compensation range listed is 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.
OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA
This position is responsible for following all Security policies and procedures in order to protect all PHI and PII 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.
As a remote-first organization handling sensitive healthcare data, Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy, data security, and compliance requirements.
REMOTE WORK TECHNICAL REQUIREMENTS
Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download, 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements.
SECONDARY EMPLOYMENT
At Guidehealth , we value transparency and collaboration as part of our commitment to excellence. As your primary employer, we kindly ask all team members to disclose any secondary employment, regardless of whether it may present a potential conflict of interest.
To ensure smooth teamwork and availability, employees must be accessible during our stated working hours. We foster connection and engagement by asking team members to join virtual meetings with their cameras on.
WHO IS GUIDEHEALTH?
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.