Patient Navigator II

About the Role

The Patient Navigator II manages complex procedures, high-end ASC cases, first-level escalations, and eligibility exceptions, serving as the senior operational liaison across scheduling, eligibility, providers, and operations.

Responsibilities

• Conducts introductory call to patients for all assigned procedures (mandatory first call, with additional calls as needed).
• Serves as the onshore liaison to the offshore eligibility and pre-certification team, reviewing findings, clarifying discrepancies, and resolving escalations.
• Independently re-verifies eligibility and benefits when discrepancies are identified to ensure accuracy prior to scheduling.
• Provides eligibility confirmation support for discrepancies, payer conflicts, or escalations.
• Acts as a backup resource for same-day procedures, emergency procedures, and Medicare add-on procedures requiring rapid validation.
• Completes mandatory patient calls within SLA, communicates authorization status and timelines, and explains out-of-pocket costs (collecting 50%–10% minimum deposits).
• Finalizes scheduling once cleared and identifies potential escalations or patient fallout.
• Documents all communication and escalates issues per policy.
• Partners with the offshore eligibility team to resolve discrepancies and performs secondary eligibility verification when required.
• Serves as the primary point of contact for initial patient fallout, addressing concerns, answering questions about insurance, cost, or process, and providing education and reassurance.
• Conducts first-level retention conversations and, if a patient elects not to proceed, escalates and coordinates handoff to the Office Manager or Vice President of Operations.
• Exercises confidentiality in all areas, abiding by HIPAA rules and regulations.
• Checks and responds to work email regularly throughout the workday.
• Participates in and completes all required trainings and in-services.
• Performs other duties as assigned.

Requirements

• High School Diploma or equivalent with a minimum of three (3) years of related experience or an equivalent combination of education and/or experience.
• Knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
• Prior experience making outbound calls using VOIP software.
• Excellent written and oral communication skills, including exceptional customer service.
• Ability to establish and maintain effective working relationships with doctors, clinical staff, co-workers, and the public.
• Ability to work individually as well as within a team.
• Ability to follow both verbal and written instructions.
• Flexible schedule to accommodate patient needs and emergent situations.
• Patience and understanding during stressful conditions related to patient health.
• Strong multitasking and prioritization skills.
• Extreme attention to detail and strong organizational skills.
• Problem-solving and reasoning abilities.
• Ability to meet predefined quality standards.
• Professional attitude and appearance at all times.
• Working knowledge of CPT and ICD-10 coding rules.
• Solid foundation of insurance knowledge and third-party payer guidelines.
• Working knowledge of the healthcare field, medical specialty, and medical terminology.
• Strong desire to provide excellent customer service and comply with organizational rules and regulations.
• High ethical and professional standards with an attitude of continuous improvement.

Preferred Qualifications

• Two (2) years’ experience working with an Electronic Medical Record (EMR).
• Medical Billing Certification.

Driving/Travel

The employee must have reliable transportation. While the primary workplace may be closest to the employee’s home, work assignments could be in any of the Company’s locations.