Patient Navigator II
Posted 12ds ago
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Job Description
Patient Navigator II coordinating complex procedure scheduling, insurance eligibility, and patient retention for a healthcare provider. Serving as liaison between patients, providers, operations, and offshore eligibility teams.
Responsibilities:
- Conduct introductory calls to patients for all assigned procedures; the first call is mandatory
- Complete additional patient calls as needed based on professional judgment
- Serve as the onshore liaison to the offshore eligibility and pre-certification team
- Review eligibility and authorization findings, clarify discrepancies, and resolve escalations
- Independently re-verify eligibility and benefits when discrepancies are identified before scheduling
- Provide eligibility confirmation support for payer conflicts, discrepancies, and escalations
- Serve as a backup resource for same-day, emergency, and Medicare add-on procedures
- Complete mandatory calls within SLA
- Communicate authorization status and timelines
- Explain out-of-pocket costs and collect deposits
- Finalize scheduling once procedures are cleared
- Identify potential escalations or patient fallout
- Document communications and escalate issues according to policy
- Serve as the primary point of contact for initial patient fallout, including hesitation or intent to cancel
- Conduct first-level retention conversations, address insurance, cost, and process questions, and provide education and reassurance
- Escalate cases and coordinate handoffs to the Office Manager, Vice President of Operations, or appropriate clinical team member when patients do not proceed
- Maintain confidentiality and comply with HIPAA rules and regulations
- Check and respond to work email regularly throughout the workday
- Participate in and complete required trainings and in-services
- Perform other duties as assigned
Requirements:
- High School Diploma or equivalent with a minimum of three (3) years related experience; or an equivalent combination of education and/or experience
- Knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook)
- Prior experience making outbound calls using VOIP software
- Excellent written and oral communication skills, including exceptional customer service
- Ability to establish and maintain effective working relationships with doctors, clinical staff, coworkers, and the public
- Ability to work individually and within a team
- Ability to follow verbal and written instructions
- Ability to work a flexible schedule
- Patience and understanding during stressful conditions related to patient health and emergent situations
- Ability to multitask and prioritize
- Extreme attention to detail
- Strong organization skills
- Problem-solving and reasoning ability
- Ability to meet predefined quality standards
- Professional attitude and appearance
- Working knowledge of CPT and ICD-10 coding rules
- Solid foundation of insurance knowledge and third-party payer guidelines
- Working knowledge of the healthcare field, medical specialty, and medical terminology
- Two (2) years’ experience working with an Electronic Medical Record (EMR) preferred
- Medical Billing Certification preferred
- Must have reliable transportation
- Must comply with HIPAA rules and regulations
Benefits:
- Reliable transportation required; work assignments may be in any of the Company’s locations
- Required trainings and in-services
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