Clinical Patient Navigator
Department: Business Development
Reports To: Call Center Manager
Summary:
The Clinical Patient Navigator assists patients in getting approval for necessary medical services by guiding them through the pre-authorization process. This role uses organizational and communication skills to help patients, work with healthcare providers and insurance companies, and ensure a smooth path to their care. The Clinical Patient Navigator is a key contact for patients needing pre-authorization, offering support and clear information.
Essential Functions:
- Pre-Authorization Support:
- Help process pre-authorization requests for different medical services like procedures, tests, and medications.
- Understand and follow the rules of different insurance companies for getting approvals.
- Enter patient and medical information accurately into computer systems.
- Help gather necessary paperwork from doctor's offices.
- Follow up on pre-authorization requests to avoid delays.
- Share the results of the pre-authorization with patients and the healthcare team clearly.
- Learn about different insurance plans and their pre-authorization rules.
- Patient Guidance:
- Be a main point of contact for patients with pre-authorization questions, offering friendly support.
- Explain the pre-authorization process to patients and their rights.
- Help patients understand what their insurance might cover and any potential costs.
- Answer patient questions and concerns politely and get help for more complex issues.
- Connect patients, doctors' offices, and insurance companies to help resolve pre-authorization issues.
- Teamwork and Communication:
- Work well with doctors, nurses, and other healthcare staff to get needed medical information.
- Communicate clearly with insurance companies to get timely approvals.
- Work with billing departments to ensure correct processing of claims.
- Participate in team meetings to improve how pre-authorizations are handled.
- Record Keeping and Following Rules:
- Keep accurate and complete records of all pre-authorization work following all guidelines.
- Protect patient privacy according to HIPAA rules.
- Report any possible issues or trends related to pre-authorization.
Qualifications:
- High school diploma or equivalent required.
- Associate's degree in Healthcare Administration or a related field is preferred.
- Experience with medical billing & EMR System a requirement.
- Bilingual in Spanish is a plus.
- Good communication and customer service skills.
- Ability to organize information and pay attention to detail.
- A desire to help patients navigate their healthcare.
- Microsoft suite(Excel, Word, outlook) experience a requirement.
Physical Requirements:
- Requires extensive periods of sitting at a desk.
- Requires frequent and repetitive typing and computer use.
Working Conditions:
- Fast-paced work environment with deadlines.
