Specialty Services Patient Navigator
About The Position
The Specialty Services Patient Navigator is responsible for being a dedicated point of contact to support patients through the health system for labs, procedures, office visits and exams, radiology studies, specialty referrals, insurance pre-certifications and authorizations for medications and appointments, completing insurance appeals, coordinating care with social support services and assisting with financial assistance for pharmaceutical and charity care programs. Acts as a liaison between insurance companies and patients by initiating financial counseling prior to service when coverage/authorization problems are identified. The Specialty Services Patient Navigator is dedicated to elevating the patient experience through their care journey.
Requirements
- High School Diploma/GED
- 1 year experience in healthcare financial services, insurance authorization, insurance verification, appeals, billing, registration or MOA/CMA role.
- 1 year experience with electronic medical record systems.
- 1 year experience of reading, analyzing and extracting documentation n patient medical charts to complete pre-certifications, pharmaceutical authorizations, procedure and testing authorizations, and the insurance appeals.
- Excellent interpersonal and communication skills.
- Solid computer skills, including proficiency with Microsoft software.
- Strong analytical and problem-solving skills, with the ability to be detail oriented.
Nice To Haves
- Associate degree in healthcare or business
- 2 years' experience pre-certification/prior authorization procedures, advanced medical terminology, reimbursement and regulatory issues, insurance functions and terminology, and utilization of charity care programs.
- 3 years' 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.
Responsibilities
- support patients through the health system for labs, procedures, office visits and exams, radiology studies, specialty referrals
- insurance pre-certifications and authorizations for medications and appointments
- completing insurance appeals
- coordinating care with social support services
- assisting with financial assistance for pharmaceutical and charity care programs
- Acts as a liaison between insurance companies and patients by initiating financial counseling prior to service when coverage/authorization problems are identified
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
1-10 employees
