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About the Role

The Patient Navigator identifies and links eligible patients and their families to primary care, mental health, restorative dental services, substance abuse treatment, specialty care, and other required services. This role involves managing insurance eligibility, prior authorizations, and coordinating referrals to aid patients in their care.

Responsibilities

• Assist in linking patients to public health insurance programs, navigating the healthcare marketplace, or securing an appointment with a managed care plan facilitator.
• Assist providers with distribution of materials related to patient care and health education.
• Assist patients with appointments to specialists.
• Track referrals in ECW, follow-up with patient, and obtain consultant reports.
• Check eligibility on insurance portals, including PCP/Dental Home listing.
• Check coordination of benefits (COB) by calling insurance companies.
• Assist with fee collection, explanation of services, and charges for patient services.
• Scrub daily claims for billing.
• Update referral list periodically.
• Obtain pre-authorization for Behavioral Health Services.
• Facilitate patient care with other Advantage Care specialists, other FQHC’s, and community providers.
• Communicate effectively with team members, providers, nurses, and administrative staff on potential barriers to care.
• Obtain linkage agreements.
• Track and reconcile referral orders for Medical and Behavioral Health Services with follow up through completion.
• Provide minimum bi-monthly Cognos Reporting to the Practice Manager for Quality Assurance and Risk Management committees.
• Collaborate with Practice Manager and Clinical Nurse Manager to identify and overcome barriers for successful referral completion.
• Perform other related duties, as assigned.

Requirements

• Basic Life Support/AED certification required.
• Strong oral, written and organizational skills required.
• Proficient in Microsoft Suite computer applications.
• Knowledge of Electronic Medical Record (EMR), required.
• Excellent patient service orientation.
• Ability to deal effectively with people and work in a team environment.

Skills

• Oral communication
• Written communication
• Organizational skills
• Microsoft Suite proficiency
• Electronic Medical Record (EMR) knowledge
• Patient service orientation
• Teamwork
• Bilingual in English and Spanish (preferred)

Experience Level

• Prior experience coordinating activities of a busy medical office or health care center, preferred.

Education Level

• Bachelor’s Degree preferred.