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Insurance Navigator
Insurance NavigatorHudson Regional Hospital • Secaucus, NJ, US
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Insurance Navigator

Insurance Navigator

Hudson Regional Hospital • Secaucus, NJ, US
30+ days ago
Job type
  • Full-time
Job description

Job Description

Job Description


Insurance Navigator (Pre-Authorization)

Department: Business Development

Reports To: Call Center Manager

Summary:

The Clinical Patient Navigator assists patients in getting approval for necessary medical services by guiding them through the pre-authorization process. This role uses organizational and communication skills to help patients, work with healthcare providers and insurance companies, and ensure a smooth path to their care. The Clinical Patient Navigator is a key contact for patients needing pre-authorization, offering support and clear information.

Essential Functions:

  • Pre-Authorization Support:
    • Help process pre-authorization requests for different medical services like procedures (inpatient, outpatient, same day surgery), tests(all kind of radiology), and medications.
    • Understand and follow the rules of different insurance companies for getting approvals.
    • Able to navigate and utilized diverse insurance's portals to obtain and or initiated pre-authorization for specific procedures.
    • Enter patient and medical information accurately into computer systems.
    • Help gather necessary paperwork from doctor's offices.
    • Follow up on pre-authorization requests to avoid delays.
    • Share the results of the pre-authorization with patients and the healthcare team clearly.
    • Learn about different insurance plans and their pre-authorization rules.
  • Patient Guidance:
    • Be a main point of contact for patients with pre-authorization questions, offering friendly support.
    • Explain the pre-authorization process to patients and their rights.
    • Help patients understand what their insurance might cover and any potential costs.
    • Answer patient questions and concerns politely and get help for more complex issues.
    • Connect patients, doctors' offices, and insurance companies to help resolve pre-authorization issues.
  • Teamwork and Communication:
    • Work well with doctors, nurses, and other healthcare staff to get needed medical information.
    • Communicate clearly with insurance companies to get timely approvals.
    • Work with billing departments to ensure correct processing of claims.
    • Participate in team meetings to improve how pre-authorizations are handled.
  • Record Keeping and Following Rules:
    • Keep accurate and complete records of all pre-authorization work following all guidelines.
    • Protect patient privacy according to HIPAA rules.
    • Report any possible issues or trends related to pre-authorization.

Qualifications:

  • High school diploma or equivalent required.
  • Associate's degree in Healthcare Administration or a related field is preferred.
  • Experience with medical billing & EMR System a requirement.
  • Bilingual in Spanish is a plus.
  • Good communication and customer service skills.
  • Ability to organize information and pay attention to detail.
  • A desire to help patients navigate their healthcare.
  • Microsoft suite(Excel, Word, outlook) experience a requirement.

Physical Requirements:

  • Requires extensive periods of sitting at a desk.
  • Requires frequent and repetitive typing and computer use.

Working Conditions:

  • Fast-paced work environment with deadlines.


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Insurance Navigator • Secaucus, NJ, US

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