Patient Navigator II

This is a fully remote position, open to applicants in New Jersey, +1 more state.

📋 Description

• Conduct initial calls to patients for all assigned procedures; the first call is essential.

• Complete additional patient calls as necessary based on professional discretion.

• Act as the onshore liaison to the offshore eligibility and pre-certification team.

• Review eligibility and authorization findings, clarify any discrepancies, and resolve escalations.

• Independently re-verify eligibility and benefits when discrepancies arise prior to scheduling.

• Provide support for eligibility confirmation in cases of payer conflicts, discrepancies, and escalations.

• Serve as a backup resource for same-day, emergency, and Medicare add-on procedures.

• Complete mandatory calls within the service level agreement (SLA).

• Communicate authorization status and timelines effectively.

• Explain out-of-pocket expenses and collect necessary deposits.

• Finalize scheduling once procedures are authorized.

• Identify potential escalations or patient fallout.

• Document communications and escalate issues according to established policies.

• Serve as the primary contact for initial patient fallout, including hesitation or intent to cancel.

• Conduct first-level retention conversations, addressing insurance, cost, and process inquiries, while providing education and reassurance.

• Escalate cases and coordinate transitions to the Office Manager, Vice President of Operations, or relevant clinical team member when patients choose not to proceed.

• Maintain confidentiality and adhere to HIPAA regulations.

• Regularly check and respond to work emails throughout the day.

• Participate in and complete all required training and in-services.

• Perform additional duties as assigned.

⛳️ Requirements

• High School Diploma or equivalent with at least three (3) years of relevant experience; or an equivalent combination of education and/or experience.

• Proficient in Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).

• Previous experience making outbound calls using VOIP software.

• Strong written and oral communication skills, including exceptional customer service abilities.

• Ability to establish and maintain effective working relationships with doctors, clinical staff, coworkers, and the public.

• Capability to work independently as well as collaboratively within a team.

• Ability to follow both verbal and written instructions accurately.

• Flexibility in working hours.

• Patience and understanding during stressful situations related to patient health and emergencies.

• Ability to multitask and prioritize effectively.

• Exceptional attention to detail.

• Strong organizational skills.

• Proficient in problem-solving and reasoning.

• Ability to meet established quality standards.

• Maintain a professional attitude and appearance.

• Familiarity with CPT and ICD-10 coding rules.

• Solid understanding of insurance knowledge and third-party payer guidelines.

• Basic knowledge of the healthcare sector, medical specialties, and medical terminology.

• Preferred: Two (2) years of experience working with an Electronic Medical Record (EMR).

• Preferred: Medical Billing Certification.

• Must have reliable transportation.

• Must comply with HIPAA regulations.

🏝️ Benefits

• Reliable transportation is required; work assignments may be located at any of the Company’s sites.

• Required trainings and in-services provided.