Sleep Wellness Pt Navigator

Griffin Hospital•Derby, CT

About The Position

This role acts as a patient navigator for sleep wellness patients, managing appointment scheduling, obtaining referrals, and collecting medical records. The position involves performing benefit investigations and responding to all incoming calls related to sleep patients, including scheduling, billing, and insurance inquiries. A key responsibility is scheduling Durable Medical Equipment (DME) setups, coordinating between patients, departments, and DME vendors based on patient zip codes. The navigator will work with FCC on authorizations for home sleep tests, tracking orders and authorizations, and maintaining patient communication throughout the process. This includes processing orders for CPAP machines and supplies, which involves completing required paperwork, forms, and sending medical records to DME vendors for insurance coverage. The individual must be knowledgeable about different insurance coverage policies and covered DME equipment. They will also work with the Sleep Educator to schedule patients once DME equipment is approved and received, and coordinate provider appointments after equipment receipt, adhering to Medicare guidelines for patient follow-up within 31 to 90 days of receiving equipment to ensure compliance. The role also functions as a Customer Service Representative, addressing patient concerns about equipment, coverage, or benefits, and relaying information to physicians, clinical staff, or DME companies. Additionally, the navigator will schedule peer-to-peer insurance reviews, submit paperwork for insurance/coverage appeals for denials, and investigate/track charts for sleep studies and machines to ensure payment through the DME company. Other duties may be assigned by the Sleep Wellness Coordinator.

Requirements

Must be well versed in all insurance coverage policies.
Must know what DME equipment is covered by each insurance company.
Must adhere to Medicare guidelines for patient follow-up.
Must be able to address all patient concerns related to equipment, coverage, or benefits.
Must be able to relay information to physicians, clinical staff or DME company as indicated.

Responsibilities

Acts as patient navigator to set up appointments, obtain referrals, and related medical records.
Performs benefit investigation.
Responds to all incoming calls for Sleep patients.
Schedules all appointments, billing and insurance inquiries.
Schedules DME setups, coordinating between patient, department and DME or required DME vendor.
Works with FCC on authorizations for home sleep tests, tracking orders and authorizations, and maintaining communication with patients.
Processes orders for CPAP machine and supplies, including filling out required paperwork, forms, and sending required medical records to DME vendor.
Works with Sleep Educator to schedule patient once DME equipment is approved and received.
Coordinates provider appointments after equipment is received, ensuring compliance with Medicare guidelines.
Acts as Customer Service Representatives for sleep patients, addressing concerns and relaying information.
Schedules peer to peer insurance reviews and submits all paperwork for insurance/coverage appeals for insurance denials.
Investigates and tracks charts for sleep studies and machines in order to receive payment through DME company.
Performs other duties as assigned by the Sleep Wellness Coordinator.