Patient Navigator

Gifthealth•Columbus, OH

1d•Remote

About The Position

At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives. Position Summary The Patient Navigator is responsible for providing exceptional customer services that include case coordination to patients and healthcare practitioners (HCPs) and their staff. This person will be a member of a large team, dedicated to supporting a high-volume call environment within a team environment. The Patient Navigator will provide education to patients or caregivers on the enrollment process, status inquiries and confirm scheduled deliveries of prescribed therapies from specialty pharmacies. To support the patient journey, the Patient Navigator will be interacting with Pharmacy Benefit Managers (PBMs) Payers (Insurers), customers (patients and healthcare providers) to gather patient information and confirm reimbursement coverage.

Requirements

High School Diploma or GED required.
Experience working in a high-volume call center is required
Thorough understanding or working knowledge of commercial and major medical insurance programs, billing requirements, healthcare benefit investigation processes, prior authorization and appeal filings
Knowledge of private payers, pharmacy benefits, medical benefits, Medicare Part D, Medicaid and alternate funding resources
Demonstrated organization and problem-solving skills to handle patient conversations identify issues and address needs
Must have comfort level multi-processing across multiple applications concurrently while capturing case information
Proficient with Microsoft Office Program Suite and Lotus Notes Suite including Excel, Word, Outlook and SharePoint
Ability to maintain professional communication skills and an understanding of how to maintain a courteous attitude toward customers and fellow employees
Requires critical thinking skills, analytical skills and the ability to work with minimal supervision.
Requires strong communication (verbal and written, clear and concise), customer service and interpersonal skills
Must be able to take appropriate action in a stressful environment
Ability to work independently or as a team member
Strong communication skills (verbal and writing) while maintaining a high degree of customer service
Ability to sit for extended periods of time while working at a computer and on the phone throughout the workday.
Ability to engage in continuous phone and computer use, including navigating multiple systems simultaneously, for the duration of the shift.
Ability to perform repetitive motions for an entire shift, including typing, mouse use, and phone handling.
Ability to view and read information on a computer screen for prolonged periods.
Ability to communicate clearly and professionally via phone, email, and internal systems.
Ability to manage a high volume of inbound and outbound calls while maintaining attention to detail and accuracy.
Ability to work in a remote environment with minimal distractions and maintain productivity and performance standards.
Ability to adapt to changing priorities, workflows, and processes in a fast-paced environment.
Ability to meet attendance, schedule adherence, and performance expectations, including flexibility for occasional extended hours or weekends as business needs require.

Nice To Haves

Associate or College Degree Preferred
Previous experience working in a pharmacy, healthcare office, or healthcare insurance provider is highly desirable

Responsibilities

Provide subject matter expertise of program requirements and reimbursement status while maintaining a high level of customer service, having a sense of urgency, being reliable, error free data entry skills, utilizing active listening skills while maintaining proper phone etiquette, utilizing great verbal and writing skills, and maintaining teamwork spirit
Single point of contact and voice for patients. Works as a patient advocate and always demonstrates compassion
Performs reimbursement related activities, such as benefit investigations, to providers and/or patients
Provide exceptional customer service to internal and external customers; resolve customer requests in a timely and accurate manner; escalate complaints according to defined SOPs
Maintain frequent phone contact with patients, third party customer service representatives and pharmacy staff
Validates completeness of all required information within case notes based on documentation or communications received from calls, providing notification of any urgent orders, shipping related issues and any errors, complaints or adverse drug events to the appropriate 3rd party or system
Reports on all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP)
Extensive knowledge of HIPAA regulations and follows all company policies
Meet performance standards in alignment with predefined metrics or KPIs
Typically receives little instruction on day-to-day work and general instructions on new assignments
Ability to be flexible and maintain composure as duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.