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, Record Keeping, HIPAA Compliance, Medical Billing, EMR System, Microsoft Suite, Attention To Detail

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, ensuring approvals for procedures, tests, and medications are obtained smoothly. This role involves acting as the main contact for patients regarding pre-authorization questions, explaining coverage, and coordinating with providers and insurance companies to resolve issues.