Client Advocate/ Patient Navigator

PURPOSE: CARE COORDINATION A patient navigator is a healthcare professional who guides a patient through the healthcare system. A patient navigator helps patients communicate with their health care providers so they get the information they need to make decisions about their health care. Patient navigators also help patients set up appointments for doctor visits and medical tests and get financial, legal, and social support. The family of A Pineywoods companies services individuals in their homes and is in need of a patient navigator with experience and knowledge of federal, veteran’s, and state healthcare programs to assist patients with accessing benefits.

REQUIRED EDUCATION AND EXPERIENCE:

• High School Diploma or equivalent required; Associates degree preferred
• Minimum of two years experience in customer service
• At least one year of experience in healthcare required, three years preferred
• Experience with Electronic Medical Record (EMR) system strongly preferred
• Minimum one year experience working in Microsoft Office, specifically Excel, Outlook and Word
• Weekend and holidays on-call rotation required

ESSENTIAL TASKS:

• Gather appropriate information for admissions to the agencies thru phone or faxed referrals and present the information to the responsible party for acceptance as admissions.
• Process referrals and orders from internal and external sources regarding patient care, responding to phone and fax inquiries, and resolving patient inquiries.
• Initiate referrals for patients for health care services or help patients choose doctors
• Act as the support person for patients who have questions on accessing state, federal, and veterans administration benefits.
• Provide support to patients on Medicare Advantage, Commercial, and other insurance types to access their policy benefits and resolve issues disrupting care.
• Assist the individual with obtaining all services they qualify across all agencies by explaining the qualifications or cost and assisting with the referral process.
• Provides social support by making referrals, providing outreach, and enlisting assistance for clients that are unable to have daily needs met.
• Assist the billing and collections departments in communicating with patients regarding payments and report monitor patient accounts receivable, reporting issues to billing.
• Verifying all payer sources and benefits including private pay, MCOs, HHSC programs, DETCOG, VA, or private insurance and refers to the appropriate agency.
• Tracks and reports efforts to resolve assigned tasks to the appropriate administrator, CEO, and CCO.
• Assist the authorization department with obtaining authorizations when directed to do so.
• Assist personnel with eligibility checks for all agencies and reports finding to the administrator, CEO, and CCO.
• Provides wellness calls to clients as directed by the administrator.
• Assist with problematic case management for the agencies with other involvement like HHSC as directed by the administrators.
• Assist the marketing team by being forward facing for healthcare fairs and education events in the communities we serve.
• Monitor and call Suspended/ Hospitalized/ Nursing Home clients weekly to assist in monitoring for service breaks and updating coverage as assigned by the administrators.
• Track and trend intake data and identify opportunities to increase referrals and efficiencies within the department.
• Understand and ensure the Intake Department follows all HIPAA, compliance, privacy, safety and confidentiality standards and processes.
• Visits referral sources when needed to ensure effective communication is achieved and maintained.

Skills and Abilities:

• Abe to efficiently and courteously work with all clinical personnel and patients and to establish effective working relationships
• Demonstrates a results' orientation for delivering appropriate products and services in an accurate, complete and timely fashion
• Must be skilled in written and verbal communications, requiring the ability to read and write effectively and efficiently
• Is able to work as scheduled and report to work on time.
• Able to multitask and manage multiple deadlines.
• Has excellent customer relation skills.
• Has excellent planning and organizational skills.
• Has excellent time management skills.
• Complies with agency policies and procedures.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday
• On call

Ability to Relocate:

• Lufkin, TX: Relocate before starting work (Required)

Work Location: In person