Intake Coordinator

About the job

• 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.

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.