The Patient Navigator supports the health system’s patients and providers by facilitating the ambulatory infusion referral process, ensuring patient access to infusion therapy at the optimal place and time. Navigates all aspects of the referral and access process, including site-of-care determination, insurance verification, prior authorization submission, and financial assistance coordination. Communicates with patients, providers, third party payers, and the Ambulatory Infusion Center (AIC) team throughout the process to ensure appropriate care coordination.
Essential Functions
- Receive and acknowledge new referrals in a timely manner to support our position as the most convenient and timely infusion provider.
- Provide direct support to patients throughout the referral and treatment process, including outbound calls for insurance information, status updates, follow ups, reauthorizations, and appointment reminders.
- Accurately capture and transcribe patient demographics, insurance information, and clinical information as necessary.
- Perform eligibility checks and benefits investigations to determine patient coverage, financial responsibility, and most appropriate site of care.
- Verify therapies meet payer medical policies to ensure appropriate coverage and reduce bad debt risk.
- Obtain prior authorization or predetermination as required by payer for ambulatory infusion services.
- Collaborate with referrals sources to obtain additional clinical information necessary to substantiate treatment.
- Coordinate peer-to-peer reviews, letters of medical necessity, or appeals as required.
- Proactively identify opportunities for financial assistance and support patient enrollment to reduce out-of-pocket expense.
- Proactively track and complete reauthorizations to prevent delays in therapy or missed treatments.
- Foster collaborative relationships with health system clinics and providers to facilitate continued referral volume.
- Answer phone calls, messages, and emails in a professional, timely manner, while maintaining patient privacy in compliance with HIPAA, PCI, and other regulations.
- Triage clinical questions to appropriate clinicians, including the Infusion RN and Nurse Practitioner.
- Complete audits and documentation as required.
- Ensure appropriate documentation of complaints, grievances, errors, adverse events, and other unanticipated outcomes according to policy.
- Other duties as assigned.
Requirements
Education
- High school diploma or GED.
Experience
- At least two years of relevant experience in patient intake, revenue operations, billing, or a clinical role within a health care facility.
- Experience with ambulatory infusion center software or electronic medical records preferred.
Knowledge, Skills, and Abilities
- Requires detailed and comprehensive knowledge of third party payers, the insurance authorization process, financial assistance programs, and medical terminology.
- Collaborates with internal and external customers to promote quality care and customer service.
- Capable of working both independently as well as part of an interdisciplinary team.
- Demonstrates critical thinking in identifying, assessing, and responding to insurance, coverage, and financial assistance issues.
- Ability to multi-task and organize workload for efficient use of time.
- Strong communication skills, including active listening, speaking, and effective writing.
- Demonstrates cultural competency, compassion, and advocacy across the health care team.
Working Conditions and Physical Requirements
- Normal office environment.
- Strength: position requires incumbent to seldom perform physical activities requiring ability to push/pull or lift objects of up to 20 pounds.
- Manual Dexterity: position requires incumbent to constantly perform simple motor skills such as standing or walking and manipulative skills such as writing; frequently perform simple and moderately difficult manipulative skills such as typing; and rarely perform difficult manipulative skills.
- Coordination: position requires incumbent to constantly perform gross body coordination such as walking and stooping and frequently perform tasks which require hand-eye coordination such as keyboard skills.
- Mobility: position requires incumbent to constantly perform mobility skills such as walking, standing, and sitting, with seldom-prolonged standing or sitting in an uncomfortable position.
- Visual Discrimination: position requires incumbent to frequently see objects closely for reading.
- Hearing: position requires incumbent to constantly be able to hear normal sound with some background noise.
Benefits
All Tulea Health employees enjoy competitive compensation with the opportunity for an annual bonus. Full-time and part-time employees receive paid time off, are eligible to participate in a 401(k) savings plan with company match, and have access to a comprehensive benefits package, including medical, dental, and vision insurance.
