Guidehealth

Understand and stay current with client contract criteria and requirements ensuring client services are compliant as well as meet client expectations. Ensure accuracy of claims processing and contract logic builds through internal audit processes. Perform targeted audits of claims processing including, but not limited to, high dollar payments, benefit matrix, interest payments, pre-payment and post-payment audits, and multiple procedure claims. Perform quality audits of claims staff, eligibility staff, and system logic.

As a Claims Analysts you will play a key role in Guidehealth’s expansion and growth. You will be responsible for the adjudication of claims that require high level review and investigation according to plan requirements and maintain an average daily quantity and quality production requirement.

As a registered nurse, you will work remotely to enhance the quality of member management, maximize satisfaction and cost effectiveness, and assist in navigating the health care system. The RN will work closely with client and members to promote wellness, problem-solve, and assist members in realization of their personal health-care related goals. This role includes telephonic member and provider outreach, data collection, and documentation.

The Client Business Manager at Guidehealth supports client success by assisting with client onboarding, operational support, and service delivery, working closely with clients, health plans, and internal teams to ensure seamless operations, build strong relationships, and contribute to Guidehealth’s mission of advancing value-based healthcare.

As the Manager, Claim Operations you will play a key role in Guidehealth’s expansion and growth. You will provide operational oversight to the claims production and the inventory and reporting teams to ensure all required KPIs and Metrics are being met.

The Manager, Clinical Care is primarily responsible for the day-to-day operations of an integrated multi-disciplinary clinical and clinical support structure that will effectively monitor, support, and lead Value Based clinical initiatives. This individual must exhibit strong leadership, management, and interpersonal skills, as well as the ability to utilize both internal and external resources to accomplish the goals and objectives of the organization.

As a Contractual Compliance Coordinator, you will ensure the accuracy of reporting and procedural and financial claims processing requirements set forth by client and Health Plan contracts. This position is responsible for regulatory and contract compliance in the managed care lines of business, including routine monitoring and audits of procedures.