Patient Care Navigator
3 weeks ago
Position Description
Title: Patient Care Navigator
The Patient Care Navigator is a key position that tracks the care coordination and care plan compliance for all Chiropractic and Medical services rendered for Personal Injury, Worker’s Compensation, and Wellness patients. The Patient Care Navigator gathers, analyzes, oversees, and manages critical information for all cases. The Patient Care Navigator is an asset for the medical office, a coordinator to all other departments, an advocate to the patient, and a liaison to all third parties to manage cases effectively and efficiently. Patient Care Navigators work on-site in medical practice office locations and collaborate with the Practice Manager and Clinic Director to be sure all aspects of a patient’s financial case are being attended to properly. The position is supported by Lead Practice Manager, Director of Clinical Support, and Corporate Case Management Team.
Position Duties:
Gathers police reports, insurance information, third-party liability information, policy coverage limits, HIPAA, letter of representation (LOR), and any other relevant information critical to the effective coordination of chiro and medical services
Tracks Care Plan Compliance to ensure the patient is receiving optimal care
Liaisons with Attorney Representative, third party representative, revenue cycle departments and any other stakeholders.
Conducts case management reviews with the Clinical Director, Practice Manager, Revenue Cycle Dept, and Corporate Case Management team.
Utilizing dashboards and reports the Patient Care Navigator analyzes patient care progress against AICA clinical pathways and creates daily goals to ensure organizational goals are realized
Communicate with internal and external stakeholders to garner clarity and direction for complex and dynamic cases
Coordinates with Verification Dept to determine patient financial responsibility
Collaborates with Clinic Front Desk to collect all patient out-of-pocket monies prior to the rendering of services
Meets with patients frequently to relay information and answer questions
Provides patient financial summary to clinics and discusses patient status with clinic leadership.
Serves as a company representative and brand ambassador to internal employees and external clients.
Position Expectations:
To perform the position successfully, an individual is expected to:
Request case information and any missing information from patients using the company-approved checklist.
Obtains police accident reports within 72 hours of care treatment start via Bycrash or Lexusnexus, or checks daily after that time for availability of the report
Obtains coverage limits within 60 days of the filing of a claim
Collects data to review and analyze personal injury cases
Requests commercial insurance coverage benefits from the verification dept
Review commercial insurance coverage benefits and patient financial responsibility with the patient face-to-face
Facilitates payment plan in accordance with Patient Financial Responsibility
Demonstrate sound decision-making based on established criteria (workflow) when reviewing cases
Daily utilization of clinic dashboard and available reports to identify gaps in patient care progress on the clinical pathway, consistently communicating with team to achieve daily goals
Prints financial summary according to policy and provides to clinic leadership
Communicate with Clinic Directors, Practice Managers, and Site Coordinators case management recommendations based on data analysis
Build and maintain relations with patients and attorney office staff
Accurately updates and maintains client case information
Demonstrates excellent communication and interpersonal skills
Utilize MS Office and Excel as effective communication tools
Utilize appropriate platforms for securing and storing case management information
Self-Starter
Organized and efficient
Professional
Maintain a positive attitude
Collaborate with the billing department to ensure accurate patient billing and resolve any discrepancies.
Maintain and update patient records, ensuring accuracy and confidentiality.
Position Metrics:
Established KPI
*Metrics may be changed/updated at any time at the discretion of management
Position Requirements:
Experience: 3+ years of medical office insurance benefit verification, upfront collections, database management, and third-party liaison experience
Possess excellent verbal, written, and interpersonal communication skills.
Excellent time management skills, organized and effectively prioritizes projects and tasks in a fast-paced and complex environment.
MS Office and Excel experience
Team-oriented and able to work with various managers and team leaders.
Effective decision making
Ability to handle patient concerns and resolve issues efficiently.
Position Miscellaneous:
Hourly employees may require overtime when requested to meet deadlines and handle issues.
Ability to attend meetings.
Ability to interact, engage, and communicate effectively with management, staff, referral sources, medical providers and patients.
Physical Demands: Frequent sitting. Occasional lifting 10-15 lbs., Occasional stooping and bending. Limited periods of uninterrupted standing and walking.
High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or a related field preferred.
Familiarity with electronic health records (EHR) systems and scheduling software.
High level of customer service and patient care focus.
Strong attention to detail, particularly in managing patient information and coordinating care.
Requirements:
Position Requirements:
Experience: 3+ years of medical office insurance benefit verification, upfront collections, database management, and third-party liaison experience
Possess excellent verbal, written, and interpersonal communication skills.
Excellent time management skills, organized, and effectively prioritizes projects and tasks in a fast-paced and complex environment.
MS Office and Excel experience
Team-oriented and able to work with various managers and team leaders.
Effective decision making
Ability to handle patient concerns and resolve issues efficiently.
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