Patient Care Navigator- Full Time- Day Shift, Hybrid

Patient Care Navigator

The following information is designed to outline the functions and position requirements of this job. It does not identify all tasks that may be expected, nor address the performance standards that must be maintained. Job functions may change based on organization need.

General Position Summary:

The Patient Care Navigator role aids in treatment coordination and is committed to removing the client's barriers to care. The person in this role will navigate the patient through the healthcare process to include educating patients on their healthcare options, explaining the pros and cons of various treatments, discussing patient financial responsibility and financing options, and ensure that they have a good understanding of what their care process is going to look like. The ideal candidate will have a strong understanding of healthcare systems and how they function as well as payer requirements. The Patient Care Navigator should be able to empathetically engage in financial conversations related to treatment options while taking the time to get to know the patient and their goals. This role requires a compassionate, positive individual who is capable of inspiring confidence in the patients you work with while promoting overall client health. Patient Navigators will work closely with the Care Team, often communicating with doctors, nurses, office managers, and other clinical staff to support positive client health outcomes.

Essential Functions / Major Responsibilities:

Coordinates patient care based on referrals/order/requests from clinicians

Creates, tracks, manages, modifies, and monitors patient authorizations as they relate to the treatment plan and in alignment with payer requirements

Organizes schedules and manages appointments for patients to ensure they receive services in a timely manner

Regularly creates and discusses with the patient any financial estimates for care

Help patients and their families navigate the process of using insurance to pay for care and educates patients on coverage and limitations

Connects the patient to financing and/or financial assistance options based on client need and organizational policy

Responsible for gathering patient data (demographics)

Schedules/Registers/pre-registers patients for treatment

Verifies insurance via verification tool

Collects patient portions of fees and posts appropriately in the EMR

Conducts daily reconciliation of all collections

Participates in departmental and hospital-wide informational meetings and in-services, including staff meetings, hospital-wide forums, and seminars.

Displays proper etiquette and mannerisms that reflect the SHINE Behavior Standards.

Promotes the Patient Safety Standards as a core value of the organization.

Communicates treatment options to the patient as directed by clinicians

Perform related tasks to make it easier for patients to receive the best possible health care at our hospital

Provide advocacy, patient education and support in accessing community-based and hospital-based programs

Assists in creating and directing communication to the referring physician to include, but not limited to, diagnostic reports, care summaries, referral outcomes, etc

Other Responsibilities:

Address data deficiencies as identified in registration/demographic data

Works no show, reschedule, cancellation report for service recovery options

Reviews department and hospital-wide policies and procedures annually.

All other duties as assigned.

Job Knowledge:

Must have excellent critical thinking skills and be able to independently solve complex issues related to care navigation and payer requirements

Must be able to communicate effectively across multiple forums

Must be able to coordinate multiple projects simultaneously.

Understand interactions/workflow between financial and clinical areas.

Must demonstrate attention to detail.

Must demonstrate advanced knowledge of healthcare coverage limitations, requirements, and financial liability

Must be have knowledge of grant, private, and public financial assistance organizations

Interpersonal Skills:

Exceptional customer-service orientation

Ability to interact effectively with colleagues, providers, clinic staff, hospital staff, administration, patients, public and outside technical people.

Effectively communicate and educate both peers and patients via written communication forums

Ability to collaborate across multi-disciplinary teams both internally and externally

Education and/or Experience:

High school diploma or equivalent (required).

Strong understanding of the needs and obstacles faced by the local patient population

Strong communication skills

Bilingual (English/Spanish) preferred

Computer literacy desirable

Basic computer skills (required).

Three or more years as a patient registrar or scheduler preferred

Experience with electronic medical systems

Knowledge of healthcare payer regulation and guidelines

Extensive knowledge of healthcare coverage tiers/product lines

Medical terminology (preferred).

CRCR credential (preferred)

OSHA Exposure Category:

Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues and are not a condition of employment.

Qualifications

High School or better.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.