Patient Account Navigator – Chemotherapy & Infusion
Job Description:
• Initiates and coordinates insurance or other carrier pre-certification and prior authorization for patients.
• Provides financial counseling to patients.
• Coordinates with the business office to ensure timely claim and account follow-up.
• Completes the pre-certification process communicating with the patient, physician, insurance company, other financial institutions and the hospital.
• Interviews patient by telephone or in person to gather financial information in order to determine discounts that may be applicable.
• Explains financial responsibilities for services received and payment options to patients and/or insurance or other financial institutes responsible for payment.
• Counsels patients regarding insurance benefits and recommends alternative sources of payment and financial assistance when appropriate.
• Reviews provider and treatment protocols, determines insurance benefits and patient responsibility, establishes payment arrangements with the patient, and documents appropriate practice management system.
• Acts as an advocate for the patient when discussing medical care with the insurance carrier or other financial institute.
• Prepares medical necessity letters for the insurance companies and other financial institutes.
• Receives and processes information and forms from the patient and insurance company.
• Assists patients with obtaining financial resources for oral medication prescriptions by working with pharmaceutical companies and other resources to obtain grants and financial aid for patients in need.
• Obtains prior authorizations from insurance to schedule patient scans and specialty clinic referrals.
• Performs other duties as assigned.
Requirements:
• High school diploma or GED required
• 12 months experience in pre-certifications, customer service, medical billing, accounts receivable or related experience required
• Medical terminology or medical insurance experience preferred
• Equivalent combination of education and experience
Benefits:
• PTO
• 401(k)
• medical and dental plans
• comprehensive benefits package
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