Patient Navigator (req95893)
Patient Navigator - Valencia, CA - Monday-Friday 8:00am - 4:30pm
Obtains and manages any required documentation (as required by state or other regulatory entities for designated testing) to determine preauthorization, informed consent requirements and other requirements from a variety of insurance plans, payers and governing sources. Handles all payer, physician and patient contact. Troubleshoots both complex medical/technical compliance and routine requests. Partner with Health Plans team to drive resolution on challenges with regards to pre-authorization and denials.
• Ability to perform all tasks of a Special Testing Services Coordinator.
• Handles client, sales, and patient inquiries regarding preauthorization and billing.
• Responds to patient complaints and assures appropriate action for resolution occurs. Handle sensitive and escalated client and patient interactions.
• Assists in documenting standard operating procedures for the Department.
• Provides input and guidance to staff members in order to ensure continuous improvement in processes which will improve customer service.
• Works with Compliance to report and resolve any billing compliance concerns.
• Supports billing teams by providing guidance with regards to facilitating appeals in order to maximize reimbursement experience. Provides training to billing teams on pre-authorization systems.
• Researches denial concerns and reports to management and billing teams in order to foster a bridge between pre-authorization and billing. Identifies and escalates reimbursement and denials issues and potential resolution techniques to management and billing teams.
• Coordinates testing in parallel to obtaining proper documentation to comply with all payer requirements.
• Documents reporting or call history in the patient file and maintains appropriate records. Also documents tools for pre-authorization team and billing teams in the form of job aids and databases which warehouse payer and process information.
• Support Health Plans team by articulating where their support is necessary, in order to drive improvements in pre-authorization process or reducing denials and write offs.
• Recognizes quality service issues and provide feedback to appropriate personnel on opportunities for improvement.
• Has ongoing responsibility for maximizing department quality and productivity by monitoring service levels and minimizing abandoned calls by supporting the phone queue.
• Other duties as required of the designated ”senior” in the department.
• Bachelor’s degree preferred, related work experience considered in lieu of a degree.
• Medical billing experience preferred; understanding of medical terminology required.
- Comfort around higher management (lab manages, medical professionals, health plan agents)
- Problem Solving
- Customer Focus
- Priority Setting
- Action oriented