The Patient Navigator II manages complex procedures, high-end ASC cases, first-level escalations, and eligibility exceptions, serving as the senior operational liaison across scheduling, eligibility, providers, and operations.
Essential Duties and Responsibilities:
- Mandatory Communication
- Conducts introductory call to patients for all assigned procedures. The first call is mandatory for all procedures. Additional calls are completed as needed based on professional judgment.
- Collaboration with Offshore Eligibility & Pre-Cert Team
- Serves as the onshore liaison to the offshore eligibility and pre-certification team.
- Reviews eligibility and authorization findings, clarify discrepancies, and assist in resolving escalations.
- Independently re-verifies eligibility and benefits when discrepancies are identified to ensure accuracy prior to scheduling.
- Eligibility & Exception Support
- Provides eligibility confirmation support when discrepancies, payer conflicts, or escalations arise.
- Acts as a backup resource for same-day procedures, emergency procedures, and Medicare add-on procedures where rapid validation is required.
- CORE Responsibilities
- Completes mandatory call(s) to patients within SLA.
- Communicates authorization status and timelines.
- Explains out-of-pocket costs and collect deposits (50% ? 10% minimum).
- Finalizes scheduling once cleared.
- Identifies potential escalations or patient fall out.
- Documents all communication and escalate issues per policy.
- Partners closely with offshore eligibility team to resolve discrepancies.
- Performs secondary eligibility verification when required.
- Serves as backup for same-day, emergency, or Medicare add-on procedures.
- Serves as the primary point of contact for initial patient fallout, including patients expressing hesitation or intent to cancel a scheduled procedure.
- Conducts a first-level retention conversation to understand patient concerns, address questions related to insurance, cost, or process, and provide appropriate education and reassurance to support informed decision-making.
- When a patient elects not to proceed after initial outreach, escalates and sees the case through to closure by coordinating handoff to the Office Manager, Vice President of Operations for the designated area or appropriate clinical team member for further discussion or final disposition.
- Exercises confidentiality in all areas, abiding by HIPAA rules and regulations.
- Checks and responds to work e-mail on a regular basis throughout the workday.
- Participates in and complete all required trainings and in-services.
- Performs other duties as assigned.
Minimum Qualifications:
- High School Diploma, or equivalent WITH a minimum of three (3) years related experience; OR an equivalent combination of education and/or experience.
- Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
- Must have prior experience making outbound calls using VOIP software.
- Must have excellent written and oral communication skills, including exceptional customer service.
- Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public.
- Must be able to work individually as well as within a team.
- Must be able to follow both verbal and written instructions.
- Must be able to work a flexible schedule.
- Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations.
- Must be able to multi-task and prioritize.
- Must demonstrate extreme attention to detail.
- Must possess strong organization skills.
- Must be able to problem solve and use reasoning.
- Must be able to meet predefined quality standards.
- Must maintain and project a professional attitude and appearance at all time.
- Must have a working knowledge of CPT and ICD-10 coding rules.
- Must have a solid foundation of insurance knowledge and guidelines for third party payers.
- Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology.
- All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance.
Preferred Qualifications:
- Two (2) years’ experience working with an Electronic Medical Record (EMR).
- Medical Billing Certification
Driving/Travel:
The employee must have reliable transportation. While the primary workplace may be closest to the employee’s home, work assignments could be in any of the Company’s locations.
