Teams at GuideWell

Manages maternity cases for expectant mothers, including high-risk pregnancies, through patient assessment, care coordination, discharge planning, treatment-plan monitoring, resource identification, cost-effective care planning, utilization review, and health-plan authorization. Collaborates with patients, families, providers, employers, and community resources while documenting goals, outcomes, and care plans. Requires an RN license, clinical nursing experience, and patient assessment expertise.

Processes and adjudicates medical, dental, vision, and mental health claims; researches benefits, coverage, medical necessity, and clinical edits. Investigates and recovers overpayments, handles appeals and complaints, interprets medical records, verifies plan loading, and authorizes payments. The role requires meeting production standards, maintaining accurate records, communicating with providers and clients, and using claims, coding, and Microsoft applications.

Processes and adjudicates medical, dental, vision, and mental health claims; researches coverage, medical necessity, benefits, appeals, and plan loading. Investigates and recovers overpayments, interprets medical records, handles complaints, negotiates settlements, and authorizes payments. The role requires claims-system experience, CPT and ICD-10 coding knowledge, familiarity with healthcare regulations, accurate data entry, sound judgment, and effective communication with providers and clients.