Clinical Patient Navigator

Job Description

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.

Full-time