Pre-Admitting Coordinator- CMH
Posted on: September 15, 2023
**Job Family** **:**
**Travel Required** **:**
**Clearance Required** **:**
The Pre-Admitting Coordinator is responsible for obtaining
precertification, and/or validating prior authorization statuses in
support of insurance specific plan requirements for all commercial,
government and other payors across hospital (inpatient &
outpatient), ancillary and clinic/ambulatory environments. In
addition, the Pre-Admitting Coordinator may be responsible for
pre-appointment registration and insurance review to maximize the
submission of a clean claim. Exemplifies the clients mission,
vision and values and acts in accordance with both Guidehouse
Managed Services and Community Memorial Healthcare policies and
High school graduate or equivalent.
1 year of experience in Patient Access, Revenue Cycle, Medical
Billing and or Financial Counseling.
Must have a basic understanding of the core Microsoft suite
offerings (Word, PowerPoint, Excel).
Excellent communication and outstanding customer service and
Basic keyboarding skills.
Ability to analyze and interpret data.
Critical thinking, sound judgment and strong problem-solving skills
Team oriented, open minded, flexible, and willing to learn.
Ability to prioritize and function effectively, efficiently, and
accurately in a multi-tasking complex, fast paced and challenging
Ability to follow oral or written instructions and established
Ability to function independently and manage own time and work
Ability to maintain Quality Assurance, Productivity and other Key
Performance Indicator (KPI) expectations/standards.
Ability to maintain confidentiality.
Associates Degree and or Revenue Cycle certifications.
Experience within a hospital or clinic environment, a health
insurance company, managed care organization or other health care
financial service setting, performing medical claims processing,
financial counseling, financial clearance, accounting, or customer
Knowledge of insurance and governmental programs, regulations, and
billing processes e.g., Medicare, Medicaid/Medi-Cal, Social
Security Disability, ChampVA, Supplemental Security Income
Disability, etc., managed care contracts and coordination of
benefits is highly desired.
Working knowledge of medical terminology and anatomy and physiology
**Essential Functions and Responsibilities:**
Reviews, collects and properly records demographic and insurance
information required to properly address the customers'
authorization requirements and identify any financial issues.
Verifies patient's eligibility from resources provided by third
party payers and portals and other on lines services.
Collects and analyzes demographic, insurance and other information
from the patient, guarantor and all other sources to accurately
ensure financial clearance of scheduled procedure/services.
Seeks information from the health plan and provides notification to
clinical partners concerning missing/pending information required
of the health plan to issue an authorization.
Contact insurance companies to ensure prior approval requirements
are met. Notify clinical partners of necessary medical information
such as history, diagnosis, CPT codes and clinical notes required
by the health plan to secure authorization.
Consistently maintains authorization accuracy rates at and or above
department standard in performance of registration and
Excellent customer-service. Able to find resolution within the
phone interaction satisfactory to the caller and/or having the
knowledge when to escalate to their supervisor and ability to
provide service recovery when needed.
Interacts and collaborates with physician practices and hospital
departments to resolve issues while also analyzing necessary
information that will ensure hospital reimbursement.
Appropriately informs the patients of hospital policies that govern
the revenue cycle, the amount owed by the patients and explains
hospital payment policy. Offers option of Financial Assistance and
Charity to assist in acceptable resolution of estimated patient
Receives, escalates and or properly responds to telephone and
electronic inquiries from patients, payers, physician practices,
hospital departments and other persons and entities.
Performs other duties as assigned for the operational effectiveness
and success of the department.
Interacts and collaborates with hospital departments to resolve
issues while also analyzing necessary information that will ensure
Maintains a working knowledge of applicable Federal, State, and
local laws and regulations, Community Memorial Healthcare
Organizational Integrity Program, Standards of Conduct, as well as
other policies and procedures to ensure adherence in a manner that
reflects honest, ethical, and professional behavior. Guards to
assure that HIPAA confidential medical information is protected and
Performs registration functions consistent with Federal, State and
Local regulatory agencies and payer requirements, and
organizational policies and procedures, including but not limited
to HIPAA privacy and security regulations, DNV and the No Surprises
Act (NSA) mandate.
Attends classroom, in person or computer based training sessions
held for the benefit of staff required by Guidehouse Managed
Services and Community Memorial Healthcare compliance
Serves as preceptor/trainers to new hires and orienteers.
Serves as a mentor to new hires and assists in new hire
Other duties as needed and assigned by the supervisor/manager.
The annual salary range for this position is $42,900.00-$64,300.00.
Compensation decisions depend on a wide range of factors, including
but not limited to skill sets, experience and training, security
clearances, licensure and certifications, and other business and
**What We Offer** **:**
Guidehouse offers a comprehensive, total rewards package that
includes competitive compensation and a flexible benefits package
that reflects our commitment to creating a diverse and supportive
+ Medical, Rx, Dental & Vision Insurance
+ Personal and Family Sick Time & Company Paid Holidays
+ Position may be eligible for a discretionary variable incentive
+ Parental Leave
+ 401(k) Retirement Plan
+ Basic Life & Supplemental Life
+ Health Savings Account, Dental/Vision & Dependent Care Flexible
+ Short-Term & Long-Term Disability
+ Tuition Reimbursement, Personal Development & Learning
+ Skills Development & Certifications
+ Employee Referral Program
+ Corporate Sponsored Events & Community Outreach
+ Emergency Back-Up Childcare Program
Guidehouse is an Equal Employment Opportunity / Affirmative Action
employer. All qualified applicants will receive consideration for
employment without regard to race, color, national origin,
ancestry, citizenship status, military status, protected veteran
status, religion, creed, physical or mental disability, medical
condition, marital status, sex, sexual orientation, gender, gender
identity or expression, age, genetic information, or any other
basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with
criminal histories in a manner consistent with the requirements of
applicable law or ordinance including the Fair Chance Ordinance of
Los Angeles and San Francisco.
If you have visited our website for information about employment
opportunities, or to apply for a position, and you require an
accommodation, please contact Guidehouse Recruiting at
1-571-633-1711 or via email at
RecruitingAccommodation@guidehouse.com . All information you
provide will be kept confidential and will be used only to the
extent required to provide needed reasonable accommodation.
_Guidehouse does not accept unsolicited resumes through or from
search firms or staffing agencies. All unsolicited resumes will be
considered the property of Guidehouse and Guidehouse will not be
obligated to pay a placement fee._
Keywords: Guidehouse, Honolulu , Pre-Admitting Coordinator- CMH, Other , Honolulu, Hawaii
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