Specialty Services Patient Navigator

Total Rewards: OSF HealthCare offers a comprehensive, market-competitive total rewards package that includes benefits, compensation, recognition, and well-being offerings focused on the whole person.

Expected pay for this position is $21.72 - $25.55/hour. Actual pay will be determined by experience, skills, and internal equity. This is an hourly position.

This job is located in Peoria, IL with a schedule of Monday through Friday, 8:30 AM to 5:00 PM.

About the Role

The Specialty Services Patient Navigator serves as a dedicated point of contact to support patients through the health system for labs, procedures, office visits, exams, radiology studies, specialty referrals, insurance pre-certifications and authorizations for medications and appointments, completing insurance appeals, coordinating care with social support services, and assisting with financial assistance for pharmaceutical and charity care programs. Acts as a liaison between insurance companies and patients by initiating financial counseling prior to service when coverage/authorization problems are identified. The Specialty Services Patient Navigator is dedicated to elevating the patient experience through their care journey.

Responsibilities

• Support patients through the health system for labs, procedures, office visits, and exams.
• Coordinate radiology studies, specialty referrals, and insurance pre-certifications and authorizations for medications and appointments.
• Complete insurance appeals and coordinate care with social support services.
• Assist with financial assistance for pharmaceutical and charity care programs.
• Act as a liaison between insurance companies and patients, initiating financial counseling when coverage/authorization issues arise.

Requirements

• High School Diploma or GED.
• 1 year of experience in healthcare financial services, insurance authorization, insurance verification, appeals, billing, registration, or MOA/CMA role.
• 1 year of experience with electronic medical record systems.
• 1 year of experience reading, analyzing, and extracting documentation from patient medical charts to complete pre-certifications, pharmaceutical authorizations, procedure and testing authorizations, and insurance appeals.
• Excellent interpersonal and communication skills.
• Solid computer skills, including proficiency with Microsoft software.
• Strong analytical and problem-solving skills, with the ability to be detail-oriented.

Preferred Qualifications

• Associate degree in healthcare or business.
• 2 years of experience with pre-certification/prior authorization procedures, advanced medical terminology, reimbursement and regulatory issues, insurance functions and terminology, and utilization of charity care programs.
• 3 years of experience in a healthcare setting with working knowledge of insurance and appeals experience related to denials management.
• Experience with heavy phone work.
• Nationally recognized Revenue Cycle certification.