Specialty Navigator II

UnitedHealth Group•Norwood, MA

89d•$18 - $32•Hybrid

About The Position

The Specialty Navigator II reviews complex referral requests and evaluates and assigns appropriate specialists for patients. Reporting to and working under the general direction of the department Supervisor(s) and Manager, this role works with patients and providers to understand requested services, interviews patients as needed, and collaborates with Specialty Nurses to support safe and appropriate clinical handoffs. The position coordinates care within Atrius Health and with external partners in the Digestive Health department. This hybrid role is based in Massachusetts and requires onsite work one day per week at 1177 Boston Providence Hwy., Norwood, MA. The schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m. EST. The role also supports phone-room coverage, responds to escalated and same-day calls, helps patients navigate referral, scheduling, insurance, and related billing matters, and protects the privacy and confidentiality of protected health information.

Requirements

High school diploma or GED.
At least 2 years of scheduling experience in a medical office setting.
At least 1 year of experience with complex surgical scheduling and working with clinical surgical providers.
Beginner-level proficiency with Microsoft Word, Excel, and Outlook.
Must reside in Massachusetts.
Must be willing and able to work onsite in Norwood one day per week.
Ability to provide professional, respectful, service-oriented customer service and remain calm in stressful situations.
Ability to make decisions based on general instructions and practices, address moderately complex problems, and seek assistance in difficult or unpredictable situations.
Ability to organize and prioritize work within general guidelines and communicate moderately complex information in written and spoken English.
Working knowledge of standard concepts, practices, procedures, and policies, and ability to work collaboratively in a small team.
Must adhere to UnitedHealth Group’s Telecommuter Policy if working as a telecommuter.
Must pass a drug test before beginning employment.

Nice To Haves

Experience in the health care industry and working with health insurance.
Experience in a hospital, physician’s office, or medical clinic.
Experience working in a call center.
Previous experience with EPIC.
Clerical or administrative support background.
Knowledge of ICD-9 and CPT codes.

Responsibilities

Review referral information from clinicians and work queues for pertinent details about tests, consultations, procedures, and referral requests; verify patient demographics and insurance information.
Review external referrals for opportunities to convert to internal referrals, explain options to patients, and redirect patients with managed-care products appropriately while ensuring safe clinical handoffs.
Obtain and relay adequate information when care is moved, working with Specialty Nurses as needed.
Explain insurance benefits, options, and denials; keep patients informed about referral status and contact them about coverage issues so they can work with their insurance company.
Notify patients of scheduled appointments, confirm appointments by mail with location and directions, and explain any required preparation.
Promote the Atrius Health System of Care by highlighting internal providers and their expertise.
Place referral orders for primary care providers when needed, research visit notes to determine whether referrals were intended, and process referrals for follow-up or annual visits.
Schedule tests, consultations, services, and procedures with other departments, local private offices, and external vendors or providers.
Respond to phone calls, faxed requests, and other referral inquiries; communicate with physicians and clinicians to obtain authorization or inform them of patient issues or required clinical paperwork.
Research patient questions and concerns about bills to determine whether they relate to the referral process, assist with referral-related billing and denied-referral matters, and refer other billing issues to appropriate staff.
Collaborate with the Practice Benefits Coordinator to help control costs, ensure services follow benefit-plan guidelines, and follow policies for non-preferred providers or vendors; coordinate second opinions as needed.
Work with supervisors to ensure patients receive timely responses and detailed answers to complex questions.
Receive escalated issues and same-day urgent calls, determine appropriate action, and work with the clinical team when a decision is needed.
De-escalate concerns from upset patients and practices using active listening, provide available options, and escalate to supervisors only when needed.
Support, train, and teach other Navigator roles as needed.
Participate in problem-solving activities focused on productivity and quality and work with supervisors on continuous departmental improvement.
Contact appropriate parties to obtain referral authorizations and verify coverage, including authorization units, insurance companies, and applicable outside agencies.
Support phone-room coverage and answer inbound calls.
Assist with scheduling patient transportation.
Access only the minimum necessary protected health information, protect its confidentiality and privacy, and comply with HIPAA and Atrius Health privacy policies and procedures.
Perform other duties as assigned.

Benefits

Paid time off accrued starting with the first pay period.
Eight paid holidays.
Medical plan options and participation in a Health Spending Account or Health Savings Account.
Dental, vision, life and AD&D insurance, and short-term and long-term disability coverage.
401(k) savings plan.
Employee Stock Purchase Plan.
Education reimbursement.
Employee discounts.
Employee Assistance Program.
Employee Referral Bonus Program.
Voluntary benefits, including pet insurance, legal insurance, and long-term care insurance.
Performance rewards and incentive and recognition programs.
Equity stock purchase and 401(k) contribution, subject to eligibility requirements.