Company Description

WHO IS GUIDEHEALTH? 

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.  

Join us as we put healthcare on a better path!!  

Job Description

The Sr. Response Analyst role is responsible for the investigation of the referral/authorization episodes to determine approval or non-approval and respond accordingly to the Home Plans requests.

WHAT YOU’LL BE DOING 

• Reviewing and finalizing 095 and PDC reports of claims sent to the Home Plan needing review and status of approval and or payment/denial.
• Reviewing and responding to the email inquiries received from the Home Plans.
• Reviewing and working on the reconciliation...