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Patient Navigator II
Clearway Pain Solutions. Manage complex procedures, high-end ASC cases, first-level escalations, and eligibility exceptions .
Tech Stack
Tools & technologiesVoIP
About the role
Key responsibilities & impact- Manage complex procedures, high-end ASC cases, first-level escalations, and eligibility exceptions
- Serve as the senior operational liaison across scheduling, eligibility, providers, and operations
- Conduct mandatory introductory calls to patients for assigned procedures and additional calls as needed
- Serve as the onshore liaison to the offshore eligibility and pre-certification team
- Review eligibility and authorization findings, clarify discrepancies, and resolve escalations
- Re-verify eligibility and benefits when discrepancies are identified before scheduling
- Provide eligibility confirmation support for payer conflicts, discrepancies, and escalations
- Support same-day, emergency, and Medicare add-on procedures requiring rapid validation
- Communicate authorization status and timelines
- Explain out-of-pocket costs and collect deposits
- Finalize scheduling once procedures are cleared
- Identify potential escalations or patient fallout
- Document communications and escalate issues according to policy
- Serve as the primary point of contact for initial patient fallout
- Conduct first-level retention conversations, address insurance/cost/process questions, and provide education and reassurance
- Coordinate handoffs to the Office Manager, Vice President of Operations, or clinical team when patients elect not to proceed
- Maintain confidentiality and comply with HIPAA rules and regulations
- Check and respond to work email regularly throughout the workday
- Complete required training and in-services
- Perform other duties as assigned
Requirements
What you’ll need- High School Diploma or equivalent with a minimum of three (3) years related experience; or an equivalent combination of education and/or experience
- Knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook)
- Prior experience making outbound calls using VOIP software
- Excellent written and oral communication skills, including exceptional customer service
- Ability to establish and maintain effective working relationships with doctors, clinical staff, co-workers, and the public
- Ability to work individually and within a team
- Ability to follow verbal and written instructions
- Ability to work a flexible schedule
- Ability to respond with patience and understanding during stressful conditions related to patient health and emergent situations
- Ability to multitask and prioritize
- Extreme attention to detail
- Strong organizational skills
- Problem-solving and reasoning abilities
- Ability to meet predefined quality standards
- Professional attitude and appearance
- Working knowledge of CPT and ICD-10 coding rules
- Solid foundation of insurance knowledge and third-party payer guidelines
- Working knowledge of the healthcare field and medical specialty
- Knowledge of medical terminology
- Reliable transportation
- Preferred: Two (2) years’ experience working with an Electronic Medical Record (EMR)
- Preferred: Medical Billing Certification
Benefits
Comp & perks- Flexible schedule
- Required trainings and in-services
- Remote work option within Maryland or New Jersey