Sleep Wellness Pt Navigator

Griffin Health Services•Derby, CT

About The Position

Acts as patient navigator to set up appointments, obtain referrals, and related medical records. Performs benefit investigation and responds to all incoming calls for Sleep patients. Schedules DME setups, coordinating between patient, department, and DME vendor based on patient zip code. Works with FCC on authorizations for home sleep tests, tracking orders and authorizations while maintaining communication with patients. Processes orders for CPAP machines and supplies, which includes filling out required paperwork and forms, and sending necessary medical records to DME vendors for insurance coverage. Must be well-versed in all insurance coverage policies, including understanding which DME equipment is covered by each insurance company. Works with the Sleep Educator to schedule patients once DME equipment is approved and received. Coordinates provider appointments after equipment is received, ensuring patients are seen between 31 and 90 days of receiving equipment per Medicare guidelines to avoid being deemed "non-compliant." Acts as a Customer Service Representative for sleep patients, addressing concerns related to equipment, coverage, or benefits, and relaying information to physicians, clinical staff, or DME companies. Schedules peer-to-peer insurance reviews and submits paperwork for insurance/coverage appeals for denials. Investigates and tracks charts for sleep studies and machines to ensure payment through the DME company. Performs other duties as 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 (31-90 days).

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.
Handles billing and insurance inquiries.
Schedules DME setups, coordinating between patient, department, and DME vendor.
Works with FCC on authorizations for home sleep tests.
Tracks orders and authorizations while maintaining communication with patients.
Processes orders for CPAP machines and supplies, including paperwork and sending medical records to DME vendors.
Understands insurance coverage policies and DME equipment coverage by insurance companies.
Works with Sleep Educator to schedule patients after DME equipment approval.
Coordinates provider appointments after equipment is received, adhering to Medicare guidelines (31-90 days).
Acts as Customer Service Representative for sleep patients, addressing concerns.
Schedules peer-to-peer insurance reviews.
Submits paperwork for insurance/coverage appeals for denials.
Investigates and tracks charts for sleep studies and machines for payment.
Performs other duties as assigned by the Sleep Wellness Coordinator.