Clinical Patient Navigator

Hudson Regional Hospital; Secaucus (NJ); On-site; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking a Clinical Patient Navigator to assist patients through the pre-authorization process for medical services. This role requires excellent communication and organizational skills to guide patients, work with healthcare providers, and ensure a smooth path to care. The ideal candidate will have a high school diploma, experience with medical billing, and a desire to help patients navigate their healthcare journey. If you're looking to make a meaningful impact in a fast-paced healthcare environment, this opportunity is for you.

Qualifications

• High school diploma required; Associate's degree preferred.
• Experience with medical billing and EMR systems required.

Responsibilities

• Assist patients with pre-authorization for medical services.
• Communicate with insurance companies for timely approvals.
• Maintain accurate records of pre-authorization work.

Skills

Communication Skills

Customer Service Skills

Organizational Skills

Detail Orientation

Bilingual in Spanish

Education

High School Diploma

Associate's Degree in Healthcare Administration

Tools

Microsoft Office Suite

Job description

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Hudson Regional Hospital provided pay range

This range is provided by Hudson Regional Hospital. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$18.00/hr - $22.00/hr

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, tests, and medications.
• Understand and follow the rules of different insurance companies for getting approvals.
• 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.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other, Information Technology, and Management

• Industries

  Hospitals and Health Care

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