Bariatric Patient Navigator
Full Time, Days
The primary purpose of the Bariatric Patient Navigator, is to help the patient navigate and educate the patient and family on the DHR Health system to obtain all information necessary prior to their surgery, regarding their treatment and diagnosis. The Bariatric Patient Navigator is responsible for the following: Meeting with the patient and explaining their surgery orders and referrals while determining insurance eligibility, financial status and eligibility by verifying insurance information via phone or on line; calling third party payers to obtain benefits to include effective dates of coverage, pre-existing condition clauses, in and out of network benefits and maximum coverage. Responsible for scheduling pre-surgical testing needed, in-office and/or in-hospital procedures, making sure necessary authorizations have been obtained, and data entry into the facility computer systems.
POSITION EDUCATION/ QUALIFICATIONS:
- High School graduate/GED certificate or equivalent is required
- Bachelor’s Degree or course work toward a Bachelor’s preferred
- Ability to read, write and speak English, bi-lingual in Spanish, and able to communicate effectively in both English and Spanish preferred
- Previous healthcare experience (2 yrs.) is required, physician or hospital experience preferred.
- Good working knowledge of insurance benefits and medical terminology required
- Knowledge of Microsoft Office suite, working knowledge of Excel required be able to type at least 35 WPM
- Previous experience working with interdisciplinary teams preferred
- Good organizational skills, written, verbal communication and excellent customer service skills are necessary
- Professionalism, good demeanor, presentation and the ability to communicate clearly and concisely with all levels of management, administration, and physicians
- Ability to schedule surgeries, for both in-hospital and in-office procedures
- Schedule, coordinate and monitor appointments of patients for pre-surgical diagnostic testing
- Ability to identify the appropriate coordination of benefits for insurance carrier
- Good overall clerical skills, ability to work productively and effectively
- ICD Codes, CPT Codes, HCPCS codes, and Modifier knowledge preferred
- Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
- Requires reasoning ability, good independent judgment and the ability to work with frequent interruptions
- Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
- Initiates communication with patient upon receiving a referral of a patient for surgery and outlines needs and identifies resources to meet those needs for each patient and ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures
- Promote supportive relationships with the patient and family, to help navigate all needed documents prior to surgery
- Provides patients and families with education, and decision making support related to the impact of medical illness, social needs, functional needs, or financial needs on healing and recovery
- Initiates, facilitates and works with internal and external resources as to meet the identified patient needs
- Obtains orders from the physician for the individual patient, continues to follow up with patient and PCP to ensure all pre-surgery appointments are attended in order to obtain “ medical clearance” for surgical procedure and acts as a liaison between physician, hospital, OP diagnostic areas, the office and the patient and his family previous to surgery
- Demonstrates proficiency of personal computers and Microsoft Office applications and other software as required.
- Appropriately monitor and verify benefits (deductibles, co-pays, coordination of benefits and co-insurance) for all accounts on the daily office visit schedule and pre-admission roster for the next day’s services.
- Confirms billing address, (information, benefit information, policy number, group name, group number, and the effective date of coverage) pre-existing conditions, in and out of network benefits and maximum coverage.
- Forwards a completed copy of schedule with applicable patient benefits to front desk staff for collection of applicable deductible and co-pay amounts.
- Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctor’s order to insurance carrier for eligibility and coverage of procedure
- Utilizes phone or on-line verification systems, i.e. TMHP, Availity, Data Link, internal system, etc., for insurance eligibility and benefits.
- Ability to determine timely filing deadline for all insurance carriers and identify the appropriate coordination of benefits for insurance carrier.
- Determines financial status and refers patient for financial screening as appropriate if patient does not have insurance coverage and needs financing options.
- Ensures referral/pre-authorization/pre-certification requirements have been met and obtains pre-certification approval as needed.
- Reviews physician order for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure
- Schedule Surgeries, for both in-hospital and in-office procedures
- Document clearly and concisely all patient benefit information on accounts through the computer system
- Has appropriate follow up and contact with hospital or patient if necessary
- Understand and adhere to managed care policies and procedures
- Perform inventory of supplies and equipment as necessary
- Answer and direct all phone calls appropriately
- Adheres to assigned projects/tasks, and volunteers for special assignments/projects
- Scans information into the EMR as needed
- Other duties as assigned