Patient Navigator

• Enroll patients in IBCCP
• Track bills, budget, and caseload; enter information into Cornerstone
• Provide case management to IBCCP enrollees diagnosed with cancer
• Work with an RN to ensure oversight
• Provide patient navigation for high-risk and newly diagnosed cancer patients, primarily breast cancer and potentially colorectal and cervical cancer patients
• Help patients understand diagnoses, treatment options, and internal and external resources
• Maintain current knowledge of community resources
• Coordinate support groups and events, including two monthly breast cancer support groups, two yearly mobile salons, and one yearly cervical and breast cancer event
• Perform other duties as assigned

• Coordinate with Center leadership to maximize daily patient census
• Participate in staff meetings to support key functions within the Center
• Greet patients and visitors, answer and route calls to appropriate staff
• Manage patient communications, including scheduling, rescheduling, and appointment reminders
• Work and schedule for providers according to the care continuum model
• Obtain and verify patient insurance information, including pre-certifications and pre-authorizations
• Enter patient insurance and charge data into appropriate databases
• Collect and enter patient charges
• Verify and reconcile charges as directed
• Prepare and transmit monthly patient survey data and documentation to providers
• Assemble new patient charts and maintain, file, and spot-check existing charts
• Coordinate and schedule ancillary testing with hospital departments
• Arrange patient transportation as needed
• Maintain office equipment, office supplies, and medical supplies as directed
• Perform other required duties

• 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

Patient Navigator II

• Conduct introductory and additional calls to patients for assigned procedures
• Serve as the onshore liaison to the offshore eligibility and pre-certification team
• Review eligibility and authorization findings, clarify discrepancies, and assist with escalations
• Re-verify eligibility and benefits when discrepancies are identified
• Provide eligibility confirmation support for payer conflicts, escalations, same-day procedures, emergency procedures, and Medicare add-on procedures
• Complete mandatory patient calls within SLA
• Communicate authorization status and timelines
• Explain out-of-pocket costs and collect deposits
• Finalize scheduling once procedures are cleared
• Identify potential escalations and patient fallout
• Document communications and escalate issues according to policy
• Serve as the primary contact for initial patient fallout, including hesitation or intent to cancel
• Conduct first-level retention conversations, address insurance, cost, and process questions, and provide education and reassurance
• Escalate cases and coordinate handoffs to the Office Manager, Vice President of Operations, or appropriate clinical team member when patients do not proceed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Check and respond to work email throughout the workday
• Complete required trainings and in-services
• Perform other duties as assigned

• Conduct introductory calls to patients for all assigned procedures; the first call is mandatory
• Complete additional patient calls as needed based on professional judgment
• Serve as the onshore liaison to the offshore eligibility and pre-certification team
• Review eligibility and authorization findings, clarify discrepancies, and resolve escalations
• Independently re-verify eligibility and benefits when discrepancies are identified before scheduling
• Provide eligibility confirmation support for payer conflicts, discrepancies, and escalations
• Serve as a backup resource for same-day, emergency, and Medicare add-on procedures
• Complete mandatory calls within SLA
• 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, including hesitation or intent to cancel
• Conduct first-level retention conversations, address insurance, cost, and process questions, and provide education and reassurance
• Escalate cases and coordinate handoffs to the Office Manager, Vice President of Operations, or appropriate clinical team member when patients do not proceed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Check and respond to work email regularly throughout the workday
• Participate in and complete required trainings and in-services
• Perform other duties as assigned

• Serve as the single point of contact for patients, caregivers, and healthcare providers
• Provide personalized case management, benefit investigations, prior authorization tracking, and appeal support
• Educate patients, healthcare providers, and stakeholders on access, reimbursement, payer policies, and Valeris programs
• Build and maintain relationships with patients, prescribers, and client stakeholders
• Coordinate with client field teams according to business rules and guidelines
• Communicate benefit coverage options and next steps in patient-friendly language
• Use electronic tools to complete benefit investigations and secure payer coverage
• Ensure compliance with healthcare laws, regulations, HIPAA, insurance guidelines, and Valeris SOPs
• Identify and escalate adverse events, product complaints, and special situation reports
• Document activities accurately in the Valeris system
• Support adherence services, patient education, and nurse teaching coordination
• Participate in team meetings and ongoing training
• Travel to the designated nearby headquarters in Morrisville, NC or Jeffersonville, IN a few times per quarter if required
• Meet training deadlines, follow SOPs, and perform assigned tasks or projects

Senior Patient Navigator

• Provide initial triage for Genomic Life services related to genetic testing, cancer diagnosis, or caregiver support
• Serve as the primary point of contact for members accessing benefits and resolve inquiries and issues
• Handle member concerns and complaints professionally and empathetically
• Initiate personalized navigation services based on patient and program requirements
• Maintain current knowledge of evidence-based healthcare and genomic information
• Document and verify required patient data using designated tools
• Track and monitor metrics and outcomes, collaborate with administration, and report findings to stakeholders
• Communicate patient information appropriately to clinical and healthcare teams
• Identify barriers to care and connect members with credible resources tailored to their needs
• Promote prevention, early detection, screening, and healthy behavior education
• Schedule appointments for Clinical Navigators and Genetic Counseling
• Request and track medical records
• Use active listening and solution-oriented approaches with patients, families, and healthcare teams
• Demonstrate empathy, integrity, honesty, compassion, cultural humility, sensitivity, and responsiveness
• Participate in collaborative team communication and escalate operational challenges to Clinical Navigation leadership
• Adhere to HIPAA privacy and confidentiality practices
• Follow GINA requirements and organizational practices for genetic information

• Ensure timely follow-up on requests and guide patients through complexities of the healthcare system
• Run and review non-adherence reports and conduct patient outreach
• Engage patients and build relationships to improve adherence to recommended care goals
• Identify critical resources and help patients navigate healthcare services and systems
• Coordinate with doctors, nurses, Care Coordinators, primary care physicians, and other healthcare providers
• Schedule services and assist with insurance coverage, including the NYS Health Exchange
• Address patient inquiries and complaints
• Provide health-related education, promotion, and support
• Maintain eRecord documentation and complete reporting requirements
• Participate in clinical and staff team meetings and recommend process improvements
• Perform other duties as assigned

• Serve as the single point of contact and provide personalized case management for patients, caregivers, and healthcare providers
• Deliver benefit investigations, prior authorization tracking, and appeal support
• Educate patients, healthcare providers, and stakeholders on access and reimbursement processes, payer policies, and Valeris programs
• Build and maintain trusted relationships with patients, prescribers, and client stakeholders
• Coordinate and collaborate with client field teams according to business rules and guidelines
• Communicate benefit coverage options and next steps in patient-friendly language
• Use electronic tools to complete benefit investigations and secure payer coverage for prescribed treatments
• Ensure compliance with healthcare laws, regulations, HIPAA, insurance guidelines, and Valeris standard operating procedures
• Identify and escalate adverse events, product complaints, and special situation reports
• Document activities in the Valeris system accurately
• Support adherence services, including patient education and nurse-teaching coordination
• Participate in team meetings and ongoing training
• Travel a few times per quarter may be required per client request to the nearest headquarters in Morrisville, NC or Jeffersonville, IN
• Complete training deadlines and follow SOPs consistently
• Perform additional assigned tasks and projects