Sleep Wellness Pt Navigator

About the Role

Acts as a patient navigator to coordinate care and administrative tasks for sleep patients, ensuring seamless communication between patients, providers, DME vendors, and insurance companies.

Responsibilities

• Set up appointments, obtain referrals, and gather related medical records for sleep patients.
• Respond to all incoming calls for sleep patients, addressing scheduling, billing, and insurance inquiries.
• Schedule DME (Durable Medical Equipment) setups, coordinating between the patient, department, and DME vendor based on patient zip code.
• Work with FCC (Facility Care Coordinator) on authorizations for home sleep tests, track orders and authorizations, and maintain communication with patients throughout the process.
• Process orders for CPAP machines and supplies, including completing required paperwork, forms, and submitting medical records to DME vendors for insurance coverage.
• Understand and navigate varying insurance coverage policies and DME equipment coverage rules for different insurance companies.
• Collaborate with the Sleep Educator to schedule patients once DME equipment is approved and received.
• Coordinate provider appointments post-equipment receipt, ensuring compliance with Medicare guidelines (patients must be seen between 31 and 90 days of receiving equipment).
• Act as a Customer Service Representative for sleep patients, addressing concerns related to equipment, coverage, or benefits and relaying information to physicians, clinical staff, or DME companies as needed.
• Schedule peer-to-peer insurance reviews and submit paperwork for insurance/coverage appeals in cases of denials.
• Investigate and track charts for sleep studies and machines to ensure payment through the DME company.
• Perform other duties as assigned by the Sleep Wellness Coordinator.