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