Intake Coordinator

Guidehealth•Chicago, IL

32d•$20 - $21•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, submitting them to the Clinical Services Department for review and finalization, and screening potential denials. The position also provides clerical support, including computer entry, handling incoming and outgoing phone calls, and accurately entering referral and pre-certification data into a software program using ICD-10 and CPT coding. Maintaining strict confidentiality of all information is crucial. The intake coordinator will also assist physician offices and providers with questions, work with Provider Relations and Claims staff to resolve discrepancies, and assist the Clinical Services Department nursing staff in developing internal referral manuals. Adherence to all audit procedures is required, along with performing other assigned duties.

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

Nice To Haves

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

Responsibilities

Initiating pre-review screening on complex referrals and/or pre-certifications and submitting to the Clinical Services Department for review and finalization.
Screening potential denials and submitting 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-certification 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.