Patient Navigator (Medical Assistant Program Completion Required)

Location Smoke Ranch Clinic, Las Vegas, NV. Schedule Monday - Friday, 7:30 AM - 4:00 PM General Duties / Responsibilities Conduct patient outreach for new, termed, and transitioned patients. Ensure member has access to PCP and specialists to coordinate care. Educate member on gaps in care and assist with scheduling provider appointments. Serve as the patient's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures. Make patient welcome calls on date of notification of assignment and/or discharge. Mail letters and correspondence as needed. Make appropriate and timely patient appointments, reminders, and confirmations. Place regular/consistent outreaches to the patient. Prepare, communicate, and follow through on patient flagpole/escalation communications to management. Communicate with PCP with any member updates and requests. Assist with obtaining medical records from any healthcare providers involved in care or hospitals. Help members with any authorizations and referrals involved in their care plan. Resolve incoming calls concerning members’ eligibility, benefits, provider information, clinical, and pharmacy needs; coordinate membership changes such as member’s primary care physician and proactively engage member with their wellness plan options. Supervisory Responsibilities: N/A Minimum Requirements To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Minimum Experience Medical assistant front and back office experience. Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations. High-volume inbound customer service experience, particularly for health plan or Medicare "Member Services" roles in health plan and supplemental benefits preferred. Telemarketing and/or member outreach experience preferred. Specialized experience in escalation or resolution units preferred. Education & Licensure High school diploma or general education degree (GED). Completion of an accredited medical assistant program. Other Skills and Abilities Independently motivated self-starter who can prioritize work assignments and make every day a productive day. Team player willing to help and support colleagues, and do their part to support us all reaching our organizational goals. Natural "teacher" with the ability to learn plans and describe/explain/educate healthcare coverage and services to our members. Genuine passion for customer service. Knowledge of ICD-10 and CPT codes. Computer proficient, able to type minimum 35 words per minute (WPM) by 10-key touch. Excellent written (email) and verbal (in-person and over the phone) communication skills. Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Able to write routine reports and correspondence. Able to speak effectively before groups of customers or employees of the organization. Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or verbal instructions. Able to deal with problems involving a few concrete variables in standardized situations. Computer Skills: Strong computer skills. Preferred Bilingual written and verbal fluency in English and Spanish, Korean, or Vietnamese. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Essential Physical Functions While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Pay Range $44,987.00 - $67,480.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Equal Opportunity Employer Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. #J-18808-Ljbffr Alignment Health