Patient Navigator

Summary Of Position

The Patient Navigator is responsible for making the patient experience smoother through coordination and processing of all patient referrals. Responsible for claims charge review edits related to the referrals, following protocols for proper authorization and processing of all referrals.

Principal Accountabilities

• Captures and coordinates complex referral authorization requests and determines course of action based on plan guidelines.
• Consults with Patient Access Manager when appropriate.
• Follows ACP protocols and standing orders for proper authorization and processing of all referrals and completes all administration functions associated with referral activities in a timely manner.
• Recommends enhanced workflows for referral management.
• Makes sure all referral reports are received and follows up in accordance with ACP policy and procedure.
• Monitors daily work queues and work lists generated from PSRs and call teams ensuring compliant referral processing and escalates any issues as appropriate to the manager.
• Acts as liaison between and advocate for patients. Addresses patient inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Explains policies and procedures to patients and refers them to the proper services required.
• Coordinates payor and group financial negotiations for out of network referrals following ACP, New York State, and payor guidelines for ensuring compliant referral processing.

Qualifications

• High School diploma or GED.
• Bachelor’s Degree in related field preferred.
• Minimum of one year of direct experience involving insurance verification, pre authorizations and other patient access functions.
• Experience coordinating referral authorizations.