Remote Prior Authorization Team Lead Jobs in Decatur, GA

WHO IS GUIDEHEALTH? 

Guidehealthis 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, Guidehealthleverages remotely-embedded Healthguides and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealthempowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. 

As a Healthguide, you will be supported by clinical teams in your strengthening of the connection between the patient and their primary care physician/medical practice staff, as well as improving the patient's health and well-being. The Healthguide engages patients and helps them navigate their care, solve their healthcare issues, and improves communication with their medical practice. 

WHAT YOU'LL BE DOING  

• Working primarily remotely, Healthguides will be working with the patient's medical practice staff and Guidehealth's Case Management team, to manage a targeted population of patients. 
• Functioning independently and being a highly collaborative team member as an extension of medical practice. 
• Assisting the patient in achieving better health outcomes by addressing their questions and concerns, connecting them with the medical practice, partnering in implementing high-impact care plans and closing care gaps, escalating medical issues, and navigating them to the right resources including assisting with referrals to specialty care and community-based organizations (CBOs). 
• Accurately documenting patients' medical history and medical issues in the electronic health record (EHR). 
• Understanding the referral and prior authorization process. 
• Continuously building a trusting, professional, working relationship with assigned medical practices and within the Guidehealth organization. 
• Implementing and meeting assigned Key Performance Indicators to produce a positive patient health outcome, while decreasing medical spend. 
• Utilize effective communication modalities (calls, texts, portals, emails) to engage and schedule high-risk patients. 
• Appropriately escalating medical issues to the Health Guide Registered Nurse, Primary Care Physician Medical practice or Guidehealth leadership. 
• Following all security policies and procedures in order to protect all PHI (Protected Health Information) under Guidehealth's custodianship as well as Guidehealth Intellectual Properties.   
• Position may require compensated travel as needed (10-15%) to clinical sites in the Atlanta, GA area for patient and provider engagement and conducting retinal eye exams with paid training provided.   

WHAT YOU'LL NEED TO HAVE 

• Certified or Registered Medical Assistant OR Certified EMT required with 2 or more years of experience.
• A love for patient coordination to serve people with complex medical and social needs.  
• Willingness to become proficient in motivational interviewing, critical listening skills and behavioral change management that lead to better patient engagement.  
• Strong interpersonal skills with a focus on empathy, patience, professionalism, and respect in all patient, team, and client interactions.
• Exceptional conversation skills and the ability to precisely document patient interviews leveraging software and in real time. 
• Experience and understanding of medical terminology and the function of a primary care physician practice. 
• Knowledge of the social determinants of health.
• Demonstrated competency and ability to independently navigate technology using multiple platforms, computer screens, and other technical components (i.e., Electronic Medical Records, care management analytics databases, phone dialing system, Microsoft Office).
• Proficiency in Microsoft Office: Outlook, Word, Excel
• Familiarity with a wide variety of electronic health records, such as: eClinicalWorks, EPIC, Athena, Cerner. Ability to balance competing priorities while remaining detail oriented and focused. 
• Exceptional written, visual and verbal communication skills. 
• Ability to track the progress of multiple tasks while ensuring that tasks are completed. 
• Ability to work independently as part of a patient's overall care team under supervision of licensed clinical professionals. 
• Demonstrated ability to work successfully in a remote work environment. 
• Reliable transportation and a valid state driver's license for occasional travel to provider sites.
• Adherence to patient confidentiality through use of a provided headset during all conversations in a private home office without distraction.
• Performance of other duties as assigned.
• Compliance with all Guidehealth policies and procedures.

The base pay range for this role is between $21-$24 per hour paid bi-weekly

ALIVE with Purpose: How We Thrive at Guidehealth 

At Guidehealth, our values come to life in everything we do. 

• We are Driven by Accountability - grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike. 
• Always Growing, Always Learning - staying curious and continuously improving inspires us to shape a better future for healthcare. 
• With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve. 
• At Guidehealth, Every Voice Matters - we believe our collective strength is rooted in the unique perspectives of each team member. 
• And through Empathy in Action, we build stronger connections with those who count on us. 
• This is what it means to be ALIVE with purpose. This is how we thrive - together - at Guidehealth. 

BENEFITS:

While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity, inclusion, and belonging are at the core of Guidehealth's values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment. 

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth's custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles, the responsibilities would be further defined by the hiring manager. 

As a remote-first organization handling sensitive healthcare data, Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy, data security, and compliance requirements.

REMOTE WORK TECHNICAL REQUIREMENTS
Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download, 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements. 

SECONDARY EMPLOYMENT

At Guidehealth, we value transparency and collaboration as part of our commitment to excellence. As your primary employer, we kindly ask all team members to disclose any secondary employment, regardless of whether it may present a potential conflict of interest. 

To ensure smooth teamwork and availability, employees must be accessible during our stated working hours. We foster connection and engagement by asking team members to join virtual meetings with their cameras on.