Overview

The Lead 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. Insurance eligibility, prior authorizations, and coordination of referrals are an integral part of this position to aid patients in coordination of their care. In addition, this person will perform other related duties as assigned on an as needed basis. 

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, to clarify and support provider instructions.
• Assist patients with specialist appointments, at time of service.
• Track referrals in ECW, follow-up with patient, and obtain consultant reports.
• Check eligibility on insurance portals, including PCP/Dental Home listing.
• Check and connect 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 among providers and support staff with new community referrals.
• 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 for specific patients.
• 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.
• Compliance with social distancing, adherence to PPE and infection protocols.
• Perform other related duties, as assigned.
• Navigate Payor’s dashboards to recruit new patients.
• Assist Practice Manager in new provider insurance onboarding and recredentialling of established providers.
• Monitor and update CAQH.
• Update Provider profile directories.

Expected Hours of Work:

Days and hours of work vary, Monday through Friday, 8:30am to 8:30pm and Saturday 8:30am-3:30pm, 35 hours per week, flexible.

Work Location:

This job operates in both the Brookville and Freeport Advantage Care Locations. Travel is regular between both locations.

Qualifications

• Bachelor’s Degree preferred.
• Basic Life Support/AED certification required.
• Strong oral, written and organizational skills required.
• Prior experience coordinating activities of a busy medical office or health care center preferred.
• 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.
• Bilingual in both English and Spanish (orally and written), preferred.