Patient Navigator-ADVTG

About the Role

The Patient Navigator identifies and links eligible patients and their families to primary care, mental health, restorative dental services, substance abuse treatment, specialty care, and other required services. Insurance eligibility, prior authorizations, and coordination of referrals are integral to this position to aid patients in coordinating their care.

Responsibilities

• Assist in linking patients to public health insurance programs, navigating the healthcare marketplace, or securing an appointment with a managed care plan facilitator.
• Assist providers with distribution of materials related to patient care and health education to clarify and support provider instructions.
• Assist patients with appointments to specialists at the time of service.
• Track referrals in ECW, follow up with patients, and obtain consultant reports.
• Check eligibility on insurance portals, including PCP/Dental Home listing.
• Check coordination of benefits (COB) by calling insurance companies.
• Assist with fee collection, explanation of services, and charges for patient services.
• Scrub daily claims for billing and update the referral list periodically.
• Obtain pre-authorization for Behavioral Health Services.
• Facilitate patient care with other Advantage Care specialists, other FQHCs, and community providers.
• Communicate effectively with team members, providers, nurses, and administrative staff on potential barriers to care for specific patients.
• Obtain linkage agreements.
• Track and reconcile referral orders for Medical and Behavioral Health Services with follow-up through completion.
• Provide minimum bi-monthly Cognos Reporting to the Practice Manager for Quality Assurance and Risk Management committees.
• Collaborate with Practice Manager and Clinical Nurse Manager to identify and overcome barriers for successful referral completion.
• Perform other related duties as assigned.

Requirements

• Bachelor’s Degree preferred.
• Basic Life Support/AED certification required.
• Strong oral, written, and organizational skills.
• Prior experience coordinating activities of a busy medical office or healthcare center preferred.
• Proficient in Microsoft Suite computer applications.
• Knowledge of Electronic Medical Record (EMR) required.
• Excellent patient service orientation.
• Ability to deal effectively with people and work in a team environment.
• Bilingual in both English and Spanish (orally and written) preferred.