LAI Financial Navigator Job – Dallas, TX

About the role

The LAI Financial Navigator manages eligibility and insurance verification for patients receiving Long-Acting Injectable (LAI) therapy. The LAI Financial Navigator’s goal is to provide continuous documentation support by helping patients maintain eligibility requirements for service continuity.

Responsibilities

• Meets with patients receiving Long-Acting Injectable (LAI) therapy to coordinate authorization, prior authorization, and Patient Assistance Program enrollments.
• Communicates with patients about their financial responsibility for services.
• Ensures eligible funding is in place for patients receiving Long-Acting Injectable (LAI) therapy to be able to receive services.
• Responds to patients’ communication in a timely manner to prioritize eligibility maintenance.
• Documents LAI eligibility status and any related notes in the Electronic Health Record.
• Conducts funding verification, eligibility, and benefits each month and ensures all prior authorization is complete prior to delivery of patient services.
• Assists patients in understanding insurance benefits and patient financial responsibilities prior to services being rendered.
• Determines need for Authorizations and assists with coordinating referrals for services.
• Submits requests to insurance for Authorizations for patient services.
• Coordinates prescription benefits and prior authorizations prior to delivery of patient services.
• Manages patient’s health record to ensure that all required information is correct and complete in the Prism Health North Texas (PHNTX) system and information is available to provide services.
• Manages enrollment and required recertifications for Patient Assistance Programs and other medication access programs.
• Coordinates with Pharmaceutical companies to ensure processing of pending applications.
• Identifies ways to improve work processes or methods and makes recommendations to the Financial Navigator Director for appropriate changes.
• Other duties as assigned.

Skills & Qualifications

• Proficiency in Excel, Word, and Outlook.
• Demonstrated knowledge and experience working with a diverse client population.
• Demonstrated ability to handle multiple responsibilities to meet tight deadlines in a complex environment.
• Demonstrated knowledge of medical terminology and clinical processes.
• Ability to make decisions related to appropriate client care.
• Ability to effectively communicate in verbal and written formats.
• Ability to establish effective working relationships with clients.
• Ability to manage and work effectively in the required electronic medical record, database, or document portal.
• Ability to work in a multi-site work environment.

Education And Experience

• A high school degree/diploma or GED.
• 5 years of experience in insurance verification and billing in a comprehensive and specialty care environment.
• Experience working with third-party billing service preferred.
• Certification in coding and billing preferred.
• Bilingual in English/Spanish is preferred.