Bariatric Patient Navigator - Advanced

VH WMC Bariatric - Admin - 159330 Winchester, Virginia Full-Time


COVID-19 VACCINE INFORMATION: To protect our patients, our workforce and our community, Valley Health is requiring that all newly hired employees and internal transfers (current employees requesting internal transfers) be fully vaccinated. Newly hired Applicants (those not currently employed by Valley Health) who have been offered a position will have to provide documentation of their vaccination status at the time of their Employee Health appointment. For internal transfers, Employee Health will contact you if they have questions around your vaccination status. Valley Health has a process for applicants who have been offered a position to request an exemption or deferral for medical or religious reasons. To search for vaccine locations, visit vaccines.gov.

Description

  • Entity: Valley Physician Enterprise (VPE)
  • Shift: Day

Who We Are

Valley Health System is a not-for-profit network of hospitals, urgent cares, physician practices, and services. Expanding across Virginia, West Virginia, and Maryland, we are devoted to the health of all who call our 18-county area home.

A vital resource for healthcare, we are the region’s largest employer, a dependable community partner, and are at the leading edge of clinical innovations.

We are looking for passionate, innovative, and caring people who will each bring their unique skills and perspectives to our workplace.

What You Will Do:

The Bariatric Patient Navigator-Advanced coordinates the front end of the revenue cycle by processing pre-registration, registration, demographic and financial verification activities. The navigator analyzes insurance payor/plans and verifies eligibility through Epic’s RTE platform or third party websites, documents responses of eligibility accurately in the patient’s medical record. Manages patients through pipeline to ensure they move through the process as efficiently as possible. The pipeline status is reported to Bariatric Coordinator and Office Manager on a monthly basis. The navigators act as a contact person for all non-clinical patient questions and concerns and manages the assignment of patients without a surgeon preference. Coordinates with verification of insurance benefits for all patients within 48 hours of seminar attendance, calls patients within 72 hours of the seminar to communicate results of benefits verification and to schedule an initial consultation appointment. The navigator counsels patients with exclusions on self-pay and financing options and meet with each patient at the end of initial consultation appointment to discuss insurance and clinical requirements and the process to surgery. Navigators are responsible for tracking patient status and entering all insurance and clinical requirements in tracking tool. They develop expertise on requirements for authorization for each insurance company with which the program works, including diet history, medically supervised weight loss, and psychological evaluation requirements. The navigators track incoming clearances in tracking tool to monitor patient progress in meeting insurance and clinical requirements, follow-up with patients monthly to check status of requirements fulfillment to keep them engaged with program and contact external providers to obtain missing paperwork on behalf of patient. They collaborate with clinical staff and providers to ensure patients have completed all requirements prior to surgery, obtain authorization for surgery according to insurance specifications and guidelines, contributes in proactive follow-up with insurance companies to check status of submissions and call patients upon insurance approval to schedule pre-op class, pre-op appointment, surgery date, and first post-op appointment. The bariatric patient navigator must be knowledgeable with insurance material; obtaining benefits and criteria, communicating the benefits and criteria to the patient in an appropriate manner so that the patient comprehends, verifying that the patients follows through with meeting the criteria, obtaining authorizations and coordinating with insurance carriers when processing appeals. The bariatric patient navigator must also be knowledgeable in coordinating, collaborating and organizing schedules with and for multiple providers. They will need to make independent decisions with insurance conflicts, counseling patients with pending tasks, regulate communication with community providers and identify if patients require additional education or clinical care.

What You Will Bring:

Education

High School Diploma or GED required
Associates required*
* Five years medical clinic experience in lieu of degree

Experience
Five years customer service related experience required
Experience working in the Bariatric field required
Experience working in a medical clinic setting required
Three years working with insurance companies and obtaining authorizations required
Experience with ICD and CPT coding required


Qualifications
Strong computer skills required
Ability to demonstrate excellent judgment required
Excellent verbal and written communication skills required
Ability to accurately document patient status required
Ability to manage multi tasks/assignments simultaneously required
Ability to function as team member and promote teamwork required

What You Will Get:

- Competitive salary
- Flexible scheduling
- Health Insurance
- Paid Time Off
- Wellness Program
- Tuition Assistance
- Retirement Plan
- Life Insurance

*some benefits are subject to change due to job status

We celebrate, support, and thrive on our differences for the benefit of our employees, our patients, and the communities we serve.
We are neighbors caring for neighbors, and our goal is always to help those we serve get well, feel well, and stay well.

EOE

Criminal Background Checks
VA State Police
3rd party Background Check

FLSA Classification
Non-exempt

Grade
109

Physical Demands
6 A Customer Service