Description

Summary & Objective

The Patient Navigation Specialist is responsible for receiving, transferring, and inputting data from referrals promptly and accurately in accordance with time frames established in the admissions workflow standard operating procedures (SOPs). The incumbent works collaboratively with CIMs and facility/agency EDs and DONs to verify eligibility for patient/resident admission, ensure admission packet information is complete, confirm bed placement, and communicate any issues potentially causing delays to the Patient Navigation Center manager. The patient navigation specialist will contribute to a strong culture of customer service internally and represent CHS’s brand to patients and the community.

Essential Functions

• Promptly transfer and input data from referrals made by the CIMs, as evidenced by 100% compliance on QA review for the SOPs implemented through the CHS UPLIFT team.
• Input all required patient intake information into the associated IT and EHR platforms (e.g., Aline, WellSky, KNS).
• Maintain pending list for assigned areas of responsibility.
• Accurately and efficiently verify insurance benefits to determine financial eligibility on Medicare, Medicaid, HMO, commercial insurance, charity care, private pay patients/residents; request and manage any required authorizations from carrier for new admissions.
• Obtain and share required medical information to facilitate timely authorization for new admissions.
• Create complete and accurate face sheet and other required admission paperwork, including assigning appropriate physician.
• Consistently communicate with CIMs, Patient Navigation Center manager, facility/agency team members, and patients and families to ensure no referrals are lost due to timely processing; escalate any barriers to facilitating patient admission to supervisor.
• Exhibit excellent customer service and a positive attitude toward CHS colleagues, physicians, patients and families, and community referral sources; participate in customer service training as required.
• Answer phone and website inquiries, and educate prospective patients, family members, physicians, and other potential referral sources for all lines of business.
• Manage bed/room assignment collaboratively with ED and/or DONs at assigned CHS facilities.
• Assists/coordinates with collection of up-front copay for new admissions when necessary.
• Maintain confidentiality of all pertinent care information for patients/residents in accordance with HIPAA guidelines and established policies and procedures.
• Cross-train on intake process for all business lines.
• Loyally represent CHS’s brand to patients and the community.

*Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

Other Duties

• Assist with orienting new employees as needed.
• Promote positive employee engagement, teamwork, mutual respect, and safe work practices.
• Demonstrate flexibility in scheduling, and readily accepts new admissions and emergency assignments as requested.
• Maintain all required licensures, certifications, and training.
• Comply with all CHS policies, as well as local, state, and federal laws and regulations.

Supervisory Responsibility

• May serve as an interim department leader depending on need.

Physical Requirements

• Must be able to lift and/or move up to 50 pounds and push/pull up to 50 pounds, walk, climb stair or ladders, stand on feet for extended periods of time, etc.

Disclaimer

The job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time.

EEOC Statement

CHS provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation and training.

Requirements

Knowledge & Experience Requirements

• High school diploma or general education degree mandatory; college degree preferred
• At least two years of experience in a healthcare facility
• Knowledge of Medicare regulations for post-acute business lines
• Knowledge and the ability to apply understanding of medical terminology
• Functional knowledge of IT systems including, but not limited to, MS Office, MS Excel, electronic health record (EHR), and payer portals; proficient and accurate typing skills
• Excellent interpersonal skills and the ability to communicate verbally and in writing effectively; bilingual preferred
• Ability to multitask, ensuring the completion of multiple tasks throughout the day
• Knowledge of computer office/clinical software and business intelligence reporting; proficiency in using healthcare software and electronical medical record systems
• Excellent verbal and written communication skills and ability to read, write, and understand English