Specialty Navigator

REMOTE IN MASSACHUSETTS reputed company is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start Caring. Connecting. Growing together.    Reporting to and working under the general direction of the Supervisor(s) and Manager of the department, the Specialty Navigator reviews reputed company referral requests and evaluates and assigns appropriate specialists for the patient. Works with patients and providers to understand services being requested. Interviews patients as needed to obtain full understanding of what information is being requested. Works closely with Specialty Nurses to ensure clinical handoffs are reputed company and appropriate. Coordinates care both reputed company reputed company and reputed company and with external partners.   Schedule (FT, 38.75 hours/week): Monday – Friday 8:30am – 5pm EST or 8:00am – 4:30pm EST If you reputed company reputed company the state of Massachusetts, you will enjoy the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: Reviews referral information from clinicians for pertinent information regarding tests, consultations and procedures             Verifies demographics and insurance information Work is highly reputed company and detail oriented, involving frequent contact with a reputed company of reputed company contacts as reputed company as the need to understand terms and processes of multiple payers Reviews referral information from work queue for pertinent information regarding referral requests Reviews reputed company external referral for opportunity to convert to internal referral and reviews reputed company with patients Redirect patients with managed care products appropriately ensuring clinical reputed company is reputed company using expertise of specialty nurses Ensures adequate information is obtained and relayed reputed company care is moved Explains insurance benefits and reputed company to patients Explain denials to patients. Keeps patient informed of status of reputed company referrals (approved and denied) Notifies patients of scheduled appointments and confirms appointments by mail including confirmed location and map of destination Inform patients of any preparation that must be completed prior to the appointment Contact patient if insurance coverage issues reputed company during the referral process so that patient can work directly with the insurance company Promotes the reputed company and reputed company System of Care by highlighting internal providers and their expertise As needed, places orders to start the referral process for the PCP on behalf of patients who have booked appointments and reputed company for the referral Research the visit notes to determine if a referral was intended as reputed company as processing referrals for follow-up or annual reputed company that require a referral Schedules patients for tests, consultations, services and procedures with other departments, local private offices, and/or reputed company vendors/providers Answers phone calls, faxed requests and other inquiries relating to referrals and communicates with the physicians and clinicians to reputed company authorization or to inform them of patient issues or clinical paperwork needed Research questions/concerns from patients regarding bills and determines if issue is reputed company to the referral process Assists in resolving billing and denied referral reputed company as they relate to the referral process Refers patients to appropriate staff (e.g., patient account representatives) for billing issues reputed company to insurance benefits and services covered under the benefits plan Works in collaboration with the person designated as the reputed company’s Benefits Coordinator to maintain cost control, ensure that services provided are reputed company benefit plan guidelines, and that necessary policies and procedures are followed reputed company dealing with non-preferred providers/vendors May coordinate second opinion requests Works with supervisors to ensure patients are receiving reputed company responses and detailed answers to their reputed company questions Research questions/concerns from patients regarding billing and determines if issue is reputed company to the referral process. Assists in resolving billing and denied referral reputed company as they relate to the referral process Receives escalated issues and stat reputed company day calls; determine appropriate reputed company and/or works with clinical team for decision Effectively deescalates issues with upset patients and practices. Uses advanced listening techniques to understand the issue and give patients reputed company as they are available. Escalates to supervisors only as needed Supports roles reputed company the Navigator Trains and teaches as needed Participates in problem solving activities, focusing on productivity and reputed company Works with supervisors to ensure reputed company improvement of the department If needed, contact appropriate parties to obtain referral authorizations and verify coverage (e.g., the Authorization Services Unit (ASU), National Imaging Associates (NIA) or individual insurance companies) Certain departments may also need to contact additional reputed company agencies for approval (e.g., American Imaging Management or Med Solutions) Customer Service: Ability to reputed company a high level of customer service to patients, visitors, staff and external customers in a reputed company, service-oriented, respectful manner using skills in reputed company listening and problem solving. Ability to remain reputed company in stressful situations Decision Making: Ability to reputed company reputed company that are guided by general instructions and practices requiring some interpretation. May reputed company recommendations for solving problems of moderate complexity and importance Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using reputed company observation, knowledge and skills based on general precedents Independence of reputed company: Ability to follow precedents and procedures. May set priorities and organize work reputed company general guidelines. Seeks assistance reputed company confronted with difficult and/or unpredictable situations. Work reputed company is monitored by supervisor/manager Written Communications: Ability to summarize and communicate in English moderately reputed company information in varied written formats to reputed company customers Oral Communications: Ability to comprehend and communicate reputed company verbal information in English to medical center staff, patients, families and external customers Knowledge: Ability to demonstrate full working knowledge of reputed company concepts, practices, procedures and policies with the ability to use them in varied situations Teamwork: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering reputed company, identifying issues, and respecting team members Complies with health and safety requirements and with regulatory agencies Complies with established departmental policies, procedures, and objectives Enhances reputed company reputed company and development through educational programs, seminars, etc. Attends a reputed company of meetings, conferences, and seminars as required or directed Regular, reliable and predictable attendance is required Performs other similar and reputed company duties as required or directed What are the reasons to consider working for reputed company?   Put it reputed company together - competitive reputed company pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your reputed company. Some of our offerings include: reputed company Time Off which you start to reputed company with your first pay period plus 8 reputed company Holidays Medical Plan reputed company along with participation in a Health Spending Account or a Health Saving account Dental, reputed company, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement Employee Discounts Employee Assistance Program Employee Referral Bonus Program Voluntary Benefits (pet insurance, reputed company insurance, LTC Insurance, etc.) You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company directions on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: High School Diploma/GED 1+ years of receptionist, reputed company support, or reputed company-reputed company experience Intermediate level of proficiency with MS Office tools Must reputed company in the state of Massachusetts Preferred Qualifications: 1+ years of experience working in a medical reputed company office position performing duties such as scheduling appointments, checking patients in/out, insurance verification, collecting co-pays and maintaining medical records Previous reputed company center experience Proficiency in reputed company Office (Word, reputed company and reputed company) Ability to learn new software (reputed company/EMR) and flexibility to attend new hire training Knowledge of reputed company EMR software Soft Skills:  Ability to work independently and maintain good judgment and accountability  Ability to prioritize tasks to meet reputed company deadlines  Ability to work reputed company under pressure in a fast-paced environment  Demonstrated ability to work reputed company with health care providers  Strong organizational and time management skills  Excellent verbal and written communication skills; ability to reputed company reputed company and concisely, conveying information in a manner that others can understand, as reputed company as ability to understand and interpret information from others   *reputed company Telecommuters will be required to adhere to reputed company’s Telecommuter Policy.      Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll reputed company a far-reaching choice of benefits and incentives. The reputed company pay for this role will reputed company from $17.98 to $32.12 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable.       At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company, and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission.           reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.      reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.          #RPO #GREEN Apply To This Job