Patient Care Navigator- Full Time- Day Shift

The following information is designed to outline the functions and position requirements of this job. It does not identify all tasks that may be expected, nor address the performance standards that must be maintained.  Job functions may change based on organization need.

General Position Summary:

The Patient Care Navigator role aids in treatment coordination and is committed to removing the client’s barriers to care. The person in this role will navigate the patient through the healthcare process to include educating patients on their healthcare options, explaining the pros and cons of various treatments, discussing patient financial responsibility and financing options, and ensure that they have a good understanding of what their care process is going to look like. The ideal candidate will have a strong understanding of healthcare systems and how they function as well as payer requirements.  The Patient Care Navigator should be able to empathetically engage in financial conversations related to treatment options while taking the time to get to know the patient and their goals. This role requires a compassionate, positive individual who is capable of inspiring confidence in the patients you work with while promoting overall client health. Patient Navigators will work closely with the Care Team, often communicating with doctors, nurses, office managers, and other clinical staff to support positive client health outcomes.

Essential Functions / Major Responsibilities:

·         Coordinates patient care based on referrals/order/requests from clinicians

·         Creates, tracks, manages, modifies, and monitors patient authorizations as they relate to the treatment plan and in alignment with payer requirements

·         Creates, tracks, manages, modifies, and monitors patient authorizations as they relate to the treatment plan and in alignment with payer requirements

·         Organizes schedules and manages appointments for patients to ensure they receive services in a timely manner

·         Regularly creates and discusses with the patient any financial estimates for care

·         Help patients and their families navigate the process of using insurance to pay for care and educates patients on coverage and limitations

·         Connects the patient to financing and/or financial assistance options based on client need and organizational policy

·         Responsible for gathering patient data (demographics)

·         Schedules/Registers/pre-registers patients for treatment

·         Verifies insurance via verification tool

·         Collects patient portions of fees and posts appropriately in the EMR

·         Conducts daily reconciliation of all collections

·         Participates in departmental and hospital-wide informational meetings and in-services, including staff meetings, hospital-wide forums, and seminars.

·         Displays proper etiquette and mannerisms that reflect the SHINE Behavior Standards.

·         Promotes the Patient Safety Standards as a core value of the organization.

·         Communicates treatment options to the patient as directed by clinicians

·         Perform related tasks to make it easier for patients to receive the best possible health care at our hospital

·         Provide advocacy, patient education and support in accessing community-based and hospital-based programs

·         Assists in creating and directing communication to the referring physician to include, but not limited to, diagnostic reports, care summaries, referral outcomes, etc

Other Responsibilities:

·         Address data deficiencies as identified in registration/demographic data

·         Works no show, reschedule, cancellation report for service recovery options

·         Reviews department and hospital-wide policies and procedures annually.

·         All other duties as assigned.

Job Knowledge:

·         Must have excellent critical thinking skills and be able to independently solve complex issues related to care navigation and payer requirements 

·         Must be able to communicate effectively across multiple forums

·         Must be able to coordinate multiple projects simultaneously.

·         Understand interactions/workflow between financial and clinical areas.

·         Must demonstrate attention to detail.

·         Must demonstrate advanced knowledge of healthcare coverage limitations, requirements, and financial liability

·         Must be have knowledge of grant, private, and public financial assistance organizations

Interpersonal Skills:

·         Exceptional customer-service orientation

·         Ability to interact effectively with colleagues, providers, clinic staff, hospital staff, administration, patients, public and outside technical people.

·         Effectively communicate and educate both peers and patients via written communication forums

·         Ability to collaborate across multi-disciplinary teams both internally and externally

Education and/or Experience:

·         High school diploma or equivalent (required).

·         Strong understanding of the needs and obstacles faced by the local patient population

·         Strong communication skills

·         Bilingual (English/Spanish) preferred

·         Computer literacy desirable

·         Basic computer skills (required).

·         Three or more years as a patient registrar or scheduler preferred

·         Experience with electronic medical systems

·         Knowledge of healthcare payer regulation and guidelines

·         Extensive knowledge of healthcare coverage tiers/product lines

·         Medical terminology (preferred).

·         CRCR credential (preferred)

 OSHA Exposure Category:

Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues and are not a condition of employment.