Patient Navigator II

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

📋 Description

• Conduct introductory and follow-up calls with patients regarding assigned procedures.

• Act as the primary contact for the offshore eligibility and pre-certification team.

• Assess eligibility and authorization findings, resolve discrepancies, and assist with escalations.

• Re-verify eligibility and benefits when discrepancies are detected.

• Provide support for eligibility confirmation in cases of payer conflicts, escalations, same-day procedures, emergency procedures, and Medicare add-on procedures.

• Complete mandatory patient calls within the specified Service Level Agreement (SLA).

• Communicate the status of authorizations and expected timelines.

• Explain out-of-pocket expenses and facilitate deposit collections.

• Finalize scheduling once procedures have been approved.

• Identify potential escalations and patient dropouts.

• Document communications and escalate issues in accordance with policy.

• Serve as the main point of contact for initial patient dropouts, including hesitance or intent to cancel.

• Conduct first-level retention discussions, addressing questions related to insurance, costs, and processes while providing education and reassurance.

• Escalate cases and coordinate transitions to the Office Manager, Vice President of Operations, or the 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.

• Complete all required training and in-service sessions.

• Perform additional duties as assigned.

⛳️ Requirements

• High School Diploma or equivalent, along with a minimum of three (3) years of related experience; or a suitable combination of education and/or experience.

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

• Previous experience making outbound calls using VOIP software.

• Excellent written and verbal communication skills, demonstrating outstanding customer service.

• Ability to establish and maintain effective relationships with physicians, clinical staff, co-workers, and the public.

• Capable of working independently as well as part of a team.

• Ability to follow both verbal and written instructions accurately.

• Willingness to work a flexible schedule.

• Patience and understanding in high-pressure situations related to patient health and emergencies.

• Proficient in multitasking and prioritizing tasks effectively.

• Strong attention to detail.

• Excellent organizational skills.

• Possess problem-solving abilities and sound reasoning skills.

• Capable of meeting established quality standards.

• Professional demeanor and appearance.

• Familiarity with CPT and ICD-10 coding guidelines.

• Solid understanding of insurance processes and third-party payer regulations.

• Working knowledge of healthcare practices, medical specialties, and medical terminology.

• Reliable transportation is necessary.

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

• Preferred: Medical Billing Certification.

🏝️ Benefits

• Reliable transportation is required for work assignments across various company locations.

• Access to required training and in-service sessions.

• Flexible scheduling options available.