Patient Navigator

Tulea Health • Baltimore, MD

9d • $25 - $30 • Onsite

About The Position

The Infusion Navigator supports the health system’s patients and providers by facilitating the ambulatory infusion referral process, ensuring patient access to infusion therapy at the optimal place and time. This role navigates all aspects of the referral and access process, including site-of-care determination, insurance verification, prior authorization submission, and financial assistance coordination. The Infusion Navigator communicates with patients, providers, third party payers, and the Ambulatory Infusion Center (AIC) team throughout the process to ensure appropriate care coordination. We are a rapidly growing organization with future advancement opportunities as we continue to expand.

Requirements

• High school diploma or GED
• Minimum of two years of relevant experience in patient intake, authorization, revenue operations, billing, or a clinical role within a health care facility
• Access to reliable transportation during work hours
• Detailed and comprehensive knowledge of third party payers, the insurance authorization process, financial assistance programs, and medical terminology
• Capable of working both independently and as part of an interdisciplinary team
• Apply critical thinking to identify, assess, and respond to insurance, coverage, and financial assistance issues
• Can multi-task and organize a workload for efficient use of time
• Communicate with impact, including active listening, speaking, and effective writing
• Demonstrate cultural competency, compassion, and advocacy across the health care team

Nice To Haves

• Experience with ambulatory infusion center software or electronic medical records preferred

Responsibilities

• Receive and acknowledge new referrals in a timely manner to support our position as the most convenient and timely infusion provider
• Provide direct support to patients throughout the referral and treatment process, including outbound calls for insurance information, status updates, follow-ups, reauthorizations, and appointment reminders
• Accurately capture and transcribe patient demographics, insurance information, and clinical information as necessary
• Perform eligibility checks and benefits investigations to determine patient coverage, financial responsibility, and most appropriate site of care
• Verify therapies meet payer medical policies to ensure appropriate coverage and reduce bad debt risk
• Obtain prior authorization or predetermination as required by payer for ambulatory infusion services
• Collaborate with referral sources to obtain additional clinical information necessary to substantiate treatment
• Coordinate peer-to-peer reviews, letters of medical necessity, or appeals as required
• Proactively identify opportunities for financial assistance and support patient enrollment to reduce out-of-pocket expense
• Proactively track and complete reauthorizations to prevent delays in therapy or missed treatments
• Foster collaborative relationships with health system clinics and providers to facilitate continued referral volume
• Answer phone calls, messages, and emails in a professional, timely manner, while maintaining patient privacy in compliance with HIPAA, PCI, and other regulations
• Triage clinical questions to appropriate clinicians, including the Infusion RN and Nurse Practitioner
• Complete audits and documentation as required
• Ensure appropriate documentation of complaints, grievances, errors, adverse events, and other unanticipated outcomes according to policy
• Perform other duties as assigned

Benefits

• Competitive compensation with annual bonus eligibility
• Comprehensive benefits package including medical, dental, vision, company-paid life & disability insurance
• Generous paid time off & holidays
• 401K plan with a company match
• Unique business model that differentiates us from our competitors
• Company culture based on compassion, adaptability, authenticity, and collaboration
• Professional growth opportunities
• Leadership commitment to high-quality care vs. focus on volume, allowing our team members to develop long-term relationships with our patients

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED