Patient Navigator
1 month ago
Job Summary: The Patient Navigator coordinates access of patients through the healthcare system from initial diagnosis or point of referral. Gathers demographic, employment, and insurance data necessary for registration and verifies insurance coverage and benefits. Gathers needed medical information for review during first appointment with physician including diagnostic procedures, operative notes, and progress notes. Functions as a liaison between patients, families, outpatient clinics, primary care physicians, and other support services. Requesting authorization for specific services as ordered by provider(s). Assists with patients in clinic environment. Performs other duties as needed.
Education and Experience: High School Diploma or GED required and one year of college preferred. Minimum one year of working with pediatric patients preferred. Minimum one year experience in a medical office front office setting and/or a hospital based call center that schedules for multiple clinics or department required.
Knowledge and Skills: Knowledge of medical terminology required. Knowledge of age appropriate vital sign parameters. Knowledge of all medical insurances and how they are used in a hospital/clinical based facility required. Full knowledge of ICD-9 and CPT codes and how they are used in HMO authorizations required. Essential Technical/Motor Skills: Able to use a variety of office equipment and tools. LLEAP functions (scheduling, referrals, outpatient documentation); Trace fax system, CCS PEDI system. Must utilize Microsoft Work, Excel, PowerPoint, Outlook and LLEAP systems. Essential Interpersonal Skills: Able to communicate effectively; telephone skills and etiquette essential; effective communicator, especially on the telephone and with individuals of differing levels of comprehension, including those who do not speak English (and Spanish Preferred); resourceful in getting necessary help; respond positively under changing circumstances; maintain patient confidentiality and a positive, supportive attitude toward patients and their families, physicians, co-workers and staff from various departments. Essential Mental Abilities: Interpret and understand patient records and various reports including, but not limited to, diagnostic procedures, laboratory findings; think critically; problem-solve; make sound decisions using common sense; work well under pressure; organize and prioritize workload effectively; multi-task; recall information with accuracy and pay close attention to detail; perform basic math functions; assess, evaluate, analyze data; communicate synthesis of information. Must work independently with minimal supervision. Essential Sensory Abilities: Able to distinguish colors as necessary; write, hear, read and speak sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with workplace; see adequately to read computer screens and written documents necessary to position.
Licensures and Certifications: Medical Assistant or Certified Nurse Assistant (CNA) certification required. Basic Life Support (BLS) Certification required.
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