Insurance Navigator

Hudson Regional Health; Secaucus (NJ); On-site; USD 42,000 - 66,000; Full time

Job summary

Hudson Regional Health in Secaucus, NJ seeks a Clinical Patient Navigator to guide patients through pre-authorization, coordinating with providers and insurers to secure approvals and clear information.

The role emphasizes patient communication, accurate data entry in EMR systems, and collaboration with the call center, doctors, and billing teams to ensure timely access to necessary care.

Qualifications

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

Responsibilities

• Help process pre-authorization requests for medical services.
• Explain the pre-authorization process to patients and their rights.
• Coordinate with doctors, insurers, and staff to gather information.
• Enter patient and medical information into computer systems accurately.
• Follow up on pre-authorization requests to avoid delays.
• Protect patient privacy and ensure HIPAA compliance.
• Serve as main point of contact for patients needing pre-authorization.

Skills

Communication skills

Customer service

Organizational skills

Typing / computer use

Bilingual in Spanish

Attention to detail

Microsoft Office proficiency

Education

High school diploma or equivalent

Associate's degree in Healthcare Administration

Tools

EMR System

Microsoft Excel

Microsoft Word

Outlook

Job description

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.

Clinical Patient Navigator

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.