Sleep Medicine Patient Navigator

Description

The RMG Sleep Medicine Patient Navigator reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

This position will have comprehensive knowledge of Sleep Medicine patient needs and will work in partnership with the physicians and clinical staff to ensure a smooth and efficient process.

This position performs registration, scheduling, insurance verification / pre-certification, and clerical functions in an accurate timely manner, and they will work closely with DME vendor delivering the highest level of customer service over the phone and in person.

Responsibilities :

• Acts as new patient navigator to set up appointments, obtain referrals, related medical records. Performs benefit investigation
• Responds to all incoming calls for Sleep patients and schedules all appointments, billing and insurance inquiries
• Schedules DME setups- coordinates between patient, department and DME or required DME vendor-depending on patient zip-code.
• Works with FCC on authorizations for home sleep tests-tracks orders and authorizations while maintaining communication with patients during this process.
• Processing orders for CPAP machine and supplies-this entails filling out required paperwork, forms, and sending required medical records to DME vendor in order for insurance to cover.

All plans have different rules and requirements and the navigator must be well versed in all the insurance coverage policies.

Must also know what DME equipment is covered by each insurance company.

• Works with Sleep Educator to schedule patient once DME equipment is approved and received.
• Coordinates provider appointments after equipment is received. Per Medicare guidelines patients must be seen between 31 and 90 days of receiving equipment.

If patients are not seen in this timeframe, they are deemed non-compliant and the entire process must be repeated.

• Acts as Customer Service Representative for sleep patients. Addresses all patient concerns related to equipment, coverage, or benefits and relays information to physicians, clinical staff or DME company as indicated.
• Schedules peer to peers insurance reviews and submits all paperwork for insurance / coverage appeals for insurance denials.
• Investigates and tracks charts for sleep studies and machines in order to receive payment through DME company.
• Schedules Telemed appointments.
• Performs other duties as assigned by Manager of Durable Medical Equipment.

Qualifications

Required :

• High School diploma or GED equivalent.
• Minimum of 3 years of medical office experience.
• Experience with electronic medical record.

Preferred :

• Procedural and insurance authorization experience.
21 days ago