Intake Coordinator

Guidehealth•Chicago, IL

32d•Remote

About The Position

The intake coordinator reviews and approves routine referrals and pre-certifications submitted while following established guidelines for our Blue Cross HMO. This role involves initiating pre-review screening on complex referrals and/or pre-certifications and submitting them to the Clinical Services Department for review and finalization. The coordinator also screens potential denials and submits them to the Clinical Services Department. Additionally, the role provides clerical support including computer entry, handling incoming and outgoing phone calls, and accurately entering referral and pre-certification information into a software program, complying with multiple sets of protocols. Maintaining strict confidentiality of all information related to health care services is crucial. The position requires accurate and timely review of referral and pre-certification authorizations, assisting physician offices and providers with related questions, and working with Provider Relations and Claims staff to clarify or rectify discrepancies. The intake coordinator will also assist the Clinical Services Department nursing staff in developing and maintaining internal referral manuals and adhere to all audit procedures. Other duties as assigned.

Requirements

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.
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.
Must disclose any secondary employment.
Must be accessible during stated working hours.
Must join virtual meetings with cameras on.

Nice To Haves

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

Responsibilities

Reviews and approves routine referrals and pre-certifications.
Initiates pre-review screening on complex referrals and/or pre-certifications and submits to the Clinical Services Department.
Screens potential denials and submits to the Clinical Services Department.
Provides clerical support with computer entry, in-coming and out-going phone calls.
Enters referral and pre-certifications complying with multiple sets of protocols.
Maintains and manages strict confidentiality of all information.
Enters 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.
Answers phone calls as well as making phone calls.
Accurately and timely reviews referral and pre-certifications authorizations.
Assists physician offices and providers with referral and precertification questions.
Works with Provider Relations and Claims staff to clarify or rectify discrepancies between referrals, precertification’s and claims.
Assists the Clinical Services Department nursing staff in the development and maintenance of internal referral manuals.
Adheres to all audit procedures.
Performs other duties as assigned.