Patient Navigator II

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

📋 Description

• Oversee intricate procedures, premium ASC cases, first-level escalations, and eligibility exceptions.

• Act as the senior operational liaison among scheduling, eligibility, providers, and operations.

• Conduct essential introductory calls with patients regarding assigned procedures and make additional calls as necessary.

• Function as the onshore contact for the offshore eligibility and pre-certification team.

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

• Reconfirm eligibility and benefits when discrepancies arise prior to scheduling.

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

• Assist with same-day, emergency, and Medicare add-on procedures that require swift validation.

• Communicate the status of authorizations and timelines.

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

• Finalize scheduling once all procedures are approved.

• Identify potential escalations or patient fallout.

• Document communications and escalate issues according to established policy.

• Serve as the main point of contact for initial patient fallout.

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

• Coordinate transitions to the Office Manager, Vice President of Operations, or clinical team when patients decide not to proceed.

• Uphold confidentiality and adhere to HIPAA regulations.

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

• Complete 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 a comparable combination of education and/or experience.

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

• Previous experience making outbound calls using VOIP software.

• Exceptional written and oral communication skills, including outstanding customer service.

• Ability to establish and sustain effective working relationships with physicians, clinical staff, colleagues, and the public.

• Capability to work independently and collaboratively within a team environment.

• Ability to follow both verbal and written instructions accurately.

• Flexibility to work a varied schedule.

• Capacity to respond with patience and understanding during stressful situations related to patient health and emergencies.

• Proficient in multitasking and prioritizing tasks effectively.

• Strong attention to detail.

• Excellent organizational skills.

• Adept problem-solving and reasoning abilities.

• Ability to meet established quality standards.

• Professional demeanor and appearance.

• Working knowledge of CPT and ICD-10 coding standards.

• Solid background in insurance knowledge and third-party payer guidelines.

• Familiarity with the healthcare sector and medical specialties.

• Understanding of medical terminology.

• Reliable means of transportation.

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

• Preferred: Medical Billing Certification.

🏝️ Benefits

• Flexible scheduling options.

• Required training and in-services provided.

• Remote work option available within Maryland or New Jersey.