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. The role coordinates support for labs, procedures, office visits and exams, radiology studies, specialty referrals, insurance pre-certifications, and authorizations for medications and appointments. The navigator also completes insurance appeals, coordinates care with social support services, and assists patients with financial assistance for pharmaceutical and charity care programs. The position acts as a liaison between insurance companies and patients, initiating financial counseling before services when coverage or authorization problems are identified. The role is focused on elevating the patient experience throughout the care journey. The position is located in Peoria, Illinois.

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.
2 years of experience with pre-certification/prior authorization procedures, advanced medical terminology, reimbursement and regulatory issues, insurance functions and terminology, and utilization of charity care programs.
3 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.

Responsibilities

Support patients through the health system for labs, procedures, office visits and exams, radiology studies, and specialty referrals.
Coordinate 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.
Act as a liaison between insurance companies and patients.
Initiate financial counseling prior to service when coverage or authorization problems are identified.
Support and elevate the patient experience throughout the care journey.