Patient Navigator

Tulea Health; Baltimore (MD); On-site; USD 52,000 - 68,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

401K plan with company match

Generous paid time off

Job summary

Tulea Health is seeking an Infusion Navigator to support patients and providers in the ambulatory infusion referral process. You will determine site of care, verify insurance, submit prior authorizations, and coordinate financial assistance.

The role requires collaboration with patients, providers, payers, and the AIC team to ensure timely access to infusion therapy and appropriate care coordination. Advancement opportunities exist as the organization grows.

Qualifications

• High school diploma or GED is required or equivalent.
• Minimum of two years of relevant experience in patient intake, authorization, revenue operations, billing, or a clinical role within a health care facility.
• Access to reliable transportation during work hours.
• Experience with ambulatory infusion center software or electronic medical records preferred.

Responsibilities

• Receive and acknowledge new referrals in a timely manner to support convenient infusion services.
• Provide direct support to patients throughout the referral and treatment process, including outreach for insurance information and reminders.
• Capture and transcribe patient demographics, insurance, and clinical information as needed.
• Perform eligibility checks and benefits investigations to determine coverage and finances.
• Obtain prior authorization or predetermination as required by payer for ambulatory infusion services.
• Coordinate with referral sources for additional clinical information as needed.
• Collaborate on peer-to-peer reviews and appeals as required.
• Identify opportunities for financial assistance and help patients with enrollment.
• Track reauthorizations to prevent delays in therapy.

Education

High school diploma or GED

Job description

At Tulea Health, we are compassionate partners seeking to elevate the infusion experience for patients through collaboration with the health systems that serve them. We create industry-leading Ambulatory Infusion Centers that deliver comfortable, consistent, caring therapy experiences personalized for each patient. Our innovative model does not compete with our health system partners but rather operates under their brand. We provide the financial investment, resources, personnel, supporting technology, and specialized expertise needed to drive success through a performance-oriented partnership model.

ROLE SUMMARY

The Infusion Navigator supports the health system’s patients and providers by facilitating the ambulatory infusion referral process, ensuring patient access to infusion therapy at the optimal place and time. This role navigates all aspects of the referral and access process, including site-of-care determination, insurance verification, prior authorization submission, and financial assistance coordination. The Infusion Navigator communicates with patients, providers, third party payers, and the Ambulatory Infusion Center (AIC) team throughout the process to ensure appropriate care coordination. We are a rapidly growing organization with future advancement opportunities as we continue to expand.

RESPONSIBILITIES

• Receive and acknowledge new referrals in a timely manner to support our position as the most convenient and timely infusion provider
• Provide direct support to patients throughout the referral and treatment process, including outbound calls for insurance information, status updates, follow-ups, reauthorizations, and appointment reminders
• Accurately capture and transcribe patient demographics, insurance information, and clinical information as necessary
• Perform eligibility checks and benefits investigations to determine patient coverage, financial responsibility, and most appropriate site of care
• Verify therapies meet payer medical policies to ensure appropriate coverage and reduce bad debt risk
• Obtain prior authorization or predetermination as required by payer for ambulatory infusion services
• Collaborate with referral sources to obtain additional clinical information necessary to substantiate treatment
• Coordinate peer-to-peer reviews, letters of medical necessity, or appeals as required
• Proactively identify opportunities for financial assistance and support patient enrollment to reduce out-of-pocket expense
• Proactively track and complete reauthorizations to prevent delays in therapy or missed treatments
• Foster collaborative relationships with health system clinics and providers to facilitate continued referral volume
• Answer phone calls, messages, and emails in a professional, timely manner, while maintaining patient privacy in compliance with HIPAA, PCI, and other regulations
• Triage clinical questions to appropriate clinicians, including the Infusion RN and Nurse Practitioner
• Complete audits and documentation as required
• Ensure appropriate documentation of complaints, grievances, errors, adverse events, and other unanticipated outcomes according to policy
• Perform other duties as assigned
• Have detailed and comprehensive knowledge of third party payers, the insurance authorization process, financial assistance programs, and medical terminology
• Collaborate effectively with internal and external customers to promote quality care and customer service
• Are capable of working both independently and as part of an interdisciplinary team
• Apply critical thinking to identify, assess, and respond to insurance, coverage, and financial assistance issues
• Can multi-task and organize a workload for efficient use of time
• Communicate with impact, including active listening, speaking, and effective writing
• Demonstrate cultural competency, compassion, and advocacy across the health care team

REQUIREMENTS & PREFERENCES

• High school diploma or GED
• Minimum of two years of relevant experience in patient intake, authorization, revenue operations, billing, or a clinical role within a health care facility
• Access to reliable transportation during work hours
• Experience with ambulatory infusion center software or electronic medical records preferred

WHAT WE OFFER

• Competitive compensation with annual bonus eligibility
• Comprehensive benefits package including medical, dental, vision, company-paid life & disability insurance
• Generous paid time off & holidays
• 401K plan with a company match
• Unique business model that differentiates us from our competitors
• Company culture based on compassion, adaptability, authenticity, and collaboration
• Professional growth opportunities
• Leadership commitment to high-quality care vs. focus on volume, allowing our team members to develop long-term relationships with our patients

EQUAL EMPLOYMENT OPPORTUNITY

Tulea Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, sexual orientation, and gender identity), national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law. Tulea Health is committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation to participate in the application or interview process, please contact [e-mail] . We participate in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the United States.