Insurance Navigator at Hudson Regional Hospital

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Full Time

Start Date

Immediate

Expiry Date

17 Jun, 26

Salary

22.0

Posted On

19 Mar, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Pre-Authorization, Organizational Skills, Communication Skills, Customer Service, Data Entry, Record Keeping, HIPAA Compliance, Medical Billing, EMR System, Microsoft Suite, Attention To Detail, Patient Guidance

Industry

Hospitals and Health Care

Description

Clinical Patient Navigator Department: Business Development Reports To: Call Center Manager Summary: The Clinical Patient Navigator assists patients in getting approval for necessary medical services by guiding them through the pre-authorization process. This role uses organizational and communication skills to help patients, work with healthcare providers and insurance companies, and ensure a smooth path to their care. The Clinical Patient Navigator is a key contact for patients needing pre-authorization, offering support and clear information. Essential Functions: * Pre-Authorization Support: * Help process pre-authorization requests for different medical services like procedures, tests, and medications. * Understand and follow the rules of different insurance companies for getting approvals. * Enter patient and medical information accurately into computer systems. * Help gather necessary paperwork from doctor's offices. * Follow up on pre-authorization requests to avoid delays. * Share the results of the pre-authorization with patients and the healthcare team clearly. * Learn about different insurance plans and their pre-authorization rules. * Patient Guidance: * Be a main point of contact for patients with pre-authorization questions, offering friendly support. * Explain the pre-authorization process to patients and their rights. * Help patients understand what their insurance might cover and any potential costs. * Answer patient questions and concerns politely and get help for more complex issues. * Connect patients, doctors' offices, and insurance companies to help resolve pre-authorization issues. * Teamwork and Communication: * Work well with doctors, nurses, and other healthcare staff to get needed medical information. * Communicate clearly with insurance companies to get timely approvals. * Work with billing departments to ensure correct processing of claims. * Participate in team meetings to improve how pre-authorizations are handled. * Record Keeping and Following Rules: * Keep accurate and complete records of all pre-authorization work following all guidelines. * Protect patient privacy according to HIPAA rules. * Report any possible issues or trends related to pre-authorization. Qualifications: * High school diploma or equivalent required. * Associate's degree in Healthcare Administration or a related field is preferred. * Experience with medical billing & EMR System a requirement. * Bilingual in Spanish is a plus. * Good communication and customer service skills. * Ability to organize information and pay attention to detail. * A desire to help patients navigate their healthcare. * Microsoft suite(Excel, Word, outlook) experience a requirement. Physical Requirements: * Requires extensive periods of sitting at a desk. * Requires frequent and repetitive typing and computer use. Working Conditions: * Fast-paced work environment with deadlines.

Responsibilities

The Clinical Patient Navigator assists patients by guiding them through the pre-authorization process for necessary medical services, requiring accurate data entry and follow-up on requests to prevent delays. This role serves as the main contact for patients regarding pre-authorization questions, explaining coverage, and resolving issues between patients, providers, and insurance companies.