Job Description

WHAT YOU’LL BE DOING

• Interpretating referral and precertification's complying with multiple sets of protocols which are built in the application.
• Maintains and manages strict confidentiality of all information, whether received directly or indirectly as it relates to health care services.
• Enter referral and precertification calls into software program accurately.
• Answer phone calls as well as make phone calls.
• Providing excellent customer service.
• Responsible for expediting calls to ensure accuracy and timeliness of referral and precertification authorizations.
• Assists physician offices and providers with referral and precertification questions.
• Works with Customer Service, Provider Relations, and Claims staff to clarify or rectify discrepancies between referrals, precertification’s, and claims.
• Adheres to all audit procedures.
• Performs other duties as assigned

Qualifications

WHAT YOU'LL NEED TO HAVE

• 1 to 3 years’ experience in customer service with referral interpretation

• Preferred medical office/customer service experience.

• Experience in a high-volume call center

• Knowledge of medical coding; including ICD-10, HCPC's and CPT codes.

• Able to adapt to different situations and multitask

• Must work independently, remain organized, 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.

WOULD LOVE FOR YOU HAVE

• Knowledge of medical terminology.

• Knowledge of HMO (Health Maintenance Organization)

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

• Positive disposition

• Hardworking

• Eager to learn

• Very dependable

• Works well with others

Additional Information

_ The base pay range for this role is between_ $18.00 to $20.00 per hour, paid bi-weekly

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 Flexible Time Off tailored to meet your needs and the needs of the business, 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.

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.