Patient Navigator - Orthopedics and Sports Medicine

FMOLHS•Baton Rouge, LA

About The Position

The Patient Navigator collaboratively supports and guides an identified patient population through receiving care within a designated specialty. The role coordinates patient care between the practice and other healthcare providers across the continuum of care, and performs administrative functions including registration, scheduling, billing, and precertification and authorizations. The Patient Navigator conveys a positive image of the clinic and provides excellent customer service. The position coordinates appointments, testing, clearances, and follow-up care; informs and educates patients about the care process; gathers test results for physician review; and responds to patient calls by assessing urgency and coordinating with clinicians. It also serves as a liaison among patients, the clinic, and insurers; handles records, paperwork, eligibility verification, authorizations, referrals, cost estimates, payments, and appeals; and may facilitate support groups, assist with educational programs, contribute to performance improvement, monitor practice expenditures, and maintain expertise in the specialty and patient population.

Requirements

Three years of administrative experience in a physician practice providing a designated procedural specialty, including registration, scheduling, insurance, and billing.
High school diploma.

Responsibilities

Schedule clinic appointments according to established procedures.
Coordinate care among providers and the hospital, including scheduling pre-operative testing, lab workups, assessments, and clearances, and work with patients to ensure completion.
Explain the care process, including workup, postoperative care, and follow-up; provide education and assess patient understanding in coordination with providers.
Gather test results and present them to the physician for review; contact patients about abnormal results and arrange further testing when needed.
Schedule follow-up appointments after procedures within the clinic and with other providers as needed.
Take patient calls, assess situations and appointment urgency, and communicate with physicians or other providers as needed.
Serve as a resource and liaison among patients, the clinic, and insurance companies regarding payment options.
Request external records and complete and submit paperwork accurately and in accordance with applicable regulations to minimize delays or denials.
Verify insurance eligibility and secure pre-authorizations and referrals.
Estimate service costs and patient responsibility, document and analyze account history, and assist with financial assistance and referrals within scope of practice.
Collect payments from patients, insurers, or other sources and coordinate appeals when appropriate.
Facilitate support groups as needed or assigned.
Assist in developing and maintaining educational programs for practice team members, medical staff, the community, or others.
Implement policies and practices; provide performance-improvement input, identify problems, facilitate solutions, and communicate findings and suggestions.
Acknowledge patient and family values and model appropriate behaviors for team members.
Monitor practice expenditures and maintain them within budget guidelines, including volume.
Maintain a high level of information and expertise regarding the specific patient population and procedural specialty.
Perform other duties as assigned.