Specialty Services Patient Navigator

OSF HealthCare•Peoria, IL

About The Position

The Specialty Services Patient Navigator serves as a dedicated point of contact to support patients as they navigate the health system for labs, procedures, office visits and exams, radiology studies, specialty referrals, insurance pre-certifications and authorizations for medications and appointments. The role includes completing insurance appeals, coordinating care with social support services, and assisting patients with financial assistance for pharmaceutical and charity care programs. The Navigator acts as a liaison between insurance companies and patients, initiating financial counseling before services when coverage or authorization problems are identified, and works to elevate the patient experience throughout the care journey. This is a surgery-scheduling position supporting the breast surgery team. The Navigator works directly with patients in person and coordinates their surgery care. The position is located in Peoria, Illinois, and its stated schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m.

Requirements

High school diploma or GED.
At least 1 year of experience in healthcare financial services, insurance authorization, insurance verification, appeals, billing, registration, or an MOA/CMA role.
At least 1 year of experience with electronic medical record systems.
At least 1 year of experience reading, analyzing, and extracting documentation from patient medical charts to complete pre-certifications, pharmaceutical authorizations, procedure and testing authorizations, and insurance appeals.
Excellent interpersonal and communication skills.
Solid computer skills, including proficiency with Microsoft software.
Strong analytical and problem-solving skills, with attention to detail.

Nice To Haves

Associate degree in healthcare or business.
Two years of experience with pre-certification or prior authorization procedures, advanced medical terminology, reimbursement and regulatory issues, insurance functions and terminology, and utilization of charity care programs.
Three years of experience in a healthcare setting, with working knowledge of insurance and appeals experience related to denials management.
Experience with heavy phone work.
Nationally recognized Revenue Cycle certification.
Past experience working with physicians.
EPIC experience.

Responsibilities

Serve as a dedicated point of contact to help patients navigate the health system for labs, procedures, office visits and exams, radiology studies, and specialty referrals.
Coordinate surgery care for patients in support of the breast surgery team.
Arrange or support insurance pre-certifications and authorizations for medications and appointments.
Complete insurance appeals.
Coordinate care with social support services.
Assist patients with financial assistance for pharmaceutical and charity care programs.
Liaise between insurance companies and patients, initiating financial counseling before services when coverage or authorization problems are identified.
Work directly with patients in person to support their care journey.