Patient Navigator/Scheduler

Description

This position will be responsible for scheduling diagnostic and surgical procedures according to the specified established protocols. This position will also be responsible for meeting with patients and aiding them in the completion of the proper forms for charity care according to the hospitals’ financial aid policy. They will be responsible for navigating the uninsured and underinsured population to resources available for insurance coverage through facility enroller programs.

Job Results & Essential Function

Patient Navigator

• Identified patient population in the Emergency room, ambulatory surgery, and inpatient setting without insurance or minimal insurance coverage and engage in resolving barriers to accessing insurance coverage programs (NYS Exchange, facility enrollers, charity care)
• Assist DSRIP Case Manager with navigating patients to services that assist uninsured or underinsured populations.

Scheduling

• Schedules patients for diagnostic testing, infusion, clinic visits, and surgical procedures as ordered by referring physicians (generally via telephone).
• Informs patients and/or physician’s staff of proper preparation and instructions for tests ordered and any pre-certifications they need to acquire.
• Pre- Register/register patients who have been referred for out-patient, clinic visits, and inpatient services.
• Prepares appropriate paperwork for the service and retains orders (requisitions) for all scheduled appointments via fax and scans them into corresponding patient accounts.
• Maintains effective communication with physician’s offices and ancillary departments within the hospital.
• Performs insurance authorization and benefit checking on all inpatient, observation, infusion, ambulatory surgery, and CT services. Refers u report daily to verify that scheduled tests were ordered and done according to the authorization obtained. Calls insurance company to request code change when the department/radiologist changes the test that was authorized.
• Runs insurance authorization report daily to verify that scheduled tests were ordered and done according to the authorization obtained. Calls insurance company to request code change when the department/radiologist changes the test that was authorized.
• Completes charge entry for professional fee services for clinic services.
• Meets with patients to assist in obtaining information and documents needed for charity care applications.
• Reports as needed to the Director and/or supervisor any issues that may affect reimbursement.

Requirements

Education & Experience

• Minimum high school diploma with 3-5 years of experience in a health care setting.
• Exposure to customer service activities
• Familiarity with various insurance plans is helpful.

Skills

• Strong ability to engage individuals from diverse backgrounds.
• Must demonstrate good interpersonal skills as well as verbal and written communication skills.
• Experience with multiple systems, including but not limited to MS Word, Excel, and PowerPoint
• Must be detailed oriented, have strong analytical skills, and be passionate about customer service.
• Ability to maintain composure in stressful situations.
• Capacity to operate with significant independence, self-motivation, empathy, and acceptance of and interest in a diverse client population.
• Knowledge of CMS and AHCCCS and other payer remits to accurately post payments, adjustments, and denials.
• In-depth knowledge of third-party payer reimbursement policies.

Physical Demands

Bending, reaching, and sitting for prolonged periods of time.

Language Ability

Ability to read, write and interpret documents in English such as safety rules, operating and maintenance instructions and procedure manuals. Ability to read, analyze and interpret common scientific/trade/technical journals. Ability to respond to common inquiries or complaints from customers, or regulatory agencies. Ability to speak effectively before groups of employees, patients, and vendors.

Math Ability

Basic math skills and competency in creating figures such as proportions, percentages, and/or ratios

Reasoning Ability

Responsible for monitoring own performance on assigned tasks. Self-directed: must make complex decisions independently and assist staff in complex decision making. Also, must possess high ethical standards with respect to discretion and regard for confidentiality.

Working Conditions

Medium noise level due to working in an open office with other staff. Steady computer usage.

This job description is a summary of the job duties and requirements that represent the general nature and level of work being performed. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. This description is not intended to limit or in any way modify the right of management to assign, direct and control the work of employees. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. All employees are expected to understand and adhere to the Standards/Code of Conduct and the Corporate Compliance Plan as well as ensure all educational requirements related to Corporate Compliance are implemented and adhered to as required by the CCP Education Plan, in addition to compliance with organizational policies and procedures, regulatory expectations, quality, and department standards, etc.

Salary : $17 - $18