
51 - 200 employees
Founded 2018
⚕️ Healthcare Insurance
🏥 Healthcare
🎯 Recruiter
Healthcare Insurance • Healthcare • Recruitment
Guide Healthcare is leading a movement where creativity delivers positive change in the healthcare sector. The company specializes in allied health service provision and healthcare recruitment, focusing on the support and treatment of older adults. With a commitment to adding value to their clients, partners, and teams, Guide Healthcare aims to do things differently in the industry.
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51 - 200 employees
Founded 2018
⚕️ Healthcare Insurance
🏥 Healthcare
🎯 Recruiter
Healthcare Insurance • Healthcare • Recruitment
Guide Healthcare is leading a movement where creativity delivers positive change in the healthcare sector. The company specializes in allied health service provision and healthcare recruitment, focusing on the support and treatment of older adults. With a commitment to adding value to their clients, partners, and teams, Guide Healthcare aims to do things differently in the industry.
• Review and approve routine referrals and pre-certifications for Blue Cross HMO • Initiate pre-review screening for complex referrals and pre-certifications • Submit complex cases and potential denials to the Clinical Services Department • Provide clerical support through computer entry and inbound/outbound phone calls • Enter referrals and pre-certifications using application protocols • Maintain confidentiality of healthcare information • Enter referrals and pre-certifications accurately using ICD-10 and CPT coding • Review referral and pre-certification authorizations accurately and promptly • Assist physician offices and providers with referral and pre-certification questions • Work with Provider Relations and Claims staff to resolve discrepancies • Assist nursing staff with internal referral manuals • Adhere to audit procedures • Perform other duties as assigned
• Prior experience in a healthcare setting • Strong knowledge of HMO • Knowledge of basic Excel functions • Knowledge of PDF Converter and/or Adobe Pro • Understanding of medical coding, including CPT and ICD-9 • Organized and task oriented • Strong time management skills • Ability to work independently • Ability to maintain strict confidentiality of healthcare information • Ability to accurately use ICD-10 and CPT coding • Employees must provide their own internet connection • Minimum internet speed of 100 Mbps download and 10 Mbps upload • Employees must be accessible during stated working hours • Must disclose any secondary employment
• Fully remote work • Necessary work equipment provided at no charge • Medical, dental, and vision plans • 401(k) plan with a 3% employer match to a 6% employee contribution • Life and disability insurance • Voluntary life insurance options • Employee Assistance Program (EAP) • Paid time off plans • Paid parental leave • Learning and development resources • Virtual meetings with cameras on to foster connection and engagement
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