Patient Navigator II

Clearway Pain Solutions; Annapolis (MD); On-site; USD 26,000 - 29,000; Full time

Benefits offered by this job

Health benefits

401(k) with employer match

PTO up to 96 hours

Paid holidays

Overtime eligibility

Job summary

Clearway Pain Solutions is seeking a Patient Navigator II to manage complex procedures and act as senior operational liaison across scheduling, eligibility, providers, and operations.

You will conduct patient outreach calls, verify eligibility, and support pre-certification reviews, while coordinating with offshore teams to ensure accurate approvals and scheduling. A customer-focused, detail-oriented approach is essential.

Qualifications

• High School Diploma or equivalent with 3 years related experience or an equivalent combination of education and/or experience.
• Proficient in Internet and Microsoft Office (Word, Excel, PowerPoint, Outlook).
• Experience making outbound calls using VOIP.
• Excellent written and oral communication, including customer service.
• Ability to work with doctors, clinical staff and the public.
• Flexible schedule and ability to multitask.
• Knowledge of CPT and ICD-10 coding rules.
• Strong insurance knowledge and third party payer guidelines.
• Healthcare field knowledge and medical terminology.

Responsibilities

• Conducts introductory calls to patients for all assigned procedures.
• Acts as onshore liaison to offshore eligibility and pre-certification team.
• Verifies eligibility and benefits; resolves discrepancies.
• Provides eligibility confirmation support for payer conflicts or escalations.
• Backup for same-day, emergency, and Medicare add-on procedures.
• Completes mandatory calls within SLA; communicates status and timelines.
• Explains out-of-pocket costs and collects deposits.
• Documents all communication and escalates issues per policy.
• Coordinates handoff for cases not proceeding after outreach.

Skills

Outbound calls (VOIP)

Microsoft Office

Communication skills

Team collaboration

Flexible schedule

CPT/ICD-10 knowledge

Insurance knowledge

Attention to detail

Organization

Problem solving

Professional conduct

Education

High School Diploma or equivalent with 3+ years related experience

EMR experience (2 years)

Medical Billing Certification

Tools

EMR software

VOIP software

Job description

The Patient Navigator II manages complex procedures, high-end ASC cases, first-level escalations, and eligibility exceptions, serving as the senior operational liaison across scheduling, eligibility, providers, and operations.

Essential Duties and Responsibilities:

• Mandatory Communication
  • Conducts introductory call to patients for all assigned procedures. The first call is mandatory for all procedures. Additional calls are completed as needed based on professional judgment.
• Collaboration with Offshore Eligibility & Pre-Cert Team
  • Serves as the onshore liaison to the offshore eligibility and pre-certification team.
  • Reviews eligibility and authorization findings, clarify discrepancies, and assist in resolving escalations.
  • Independently re-verifies eligibility and benefits when discrepancies are identified to ensure accuracy prior to scheduling.
• Eligibility & Exception Support
  • Provides eligibility confirmation support when discrepancies, payer conflicts, or escalations arise.
  • Acts as a backup resource for same-day procedures, emergency procedures, and Medicare add-on procedures where rapid validation is required.
• CORE Responsibilities
  • Completes mandatory call(s) to patients within SLA.
  • Communicates authorization status and timelines.
  • Explains out-of-pocket costs and collect deposits (50% ? 10% minimum).
  • Finalizes scheduling once cleared.
  • Identifies potential escalations or patient fall out.
  • Documents all communication and escalates issues per policy.
  • Partners closely with offshore eligibility team to resolve discrepancies.
  • Performs secondary eligibility verification when required.
  • Serves as backup for same-day, emergency, or Medicare add-on procedures.
  • Serves as the primary point of contact for initial patient fallout, including patients expressing hesitation or intent to cancel a scheduled procedure.
  • Conducts a first-level retention conversation to understand patient concerns, address questions related to insurance, cost, or process, and provide appropriate education and reassurance to support informed decision-making.
  • When a patient elects not to proceed after initial outreach, escalates and sees the case through to closure by coordinating handoff to the Office Manager, Vice President of Operations for the designated area or appropriate clinical team member for further discussion or final disposition.
  • Exercises confidentiality in all areas, abiding by HIPAA rules and regulations.
  • Checks and responds to work e-mail on a regular basis throughout the workday.
  • Participates in and completes all required trainings and in-services.
  • Performs other duties as assigned.

Minimum Qualifications:

• High School Diploma, or equivalent WITH a minimum of three (3) years related experience; OR an equivalent combination of education and/or experience.
• Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
• Must have prior experience making outbound calls using VOIP software.
• Must have excellent written and oral communication skills, including exceptional customer service.
• Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public.
• Must be able to work individually as well as within a team.
• Must be able to follow both verbal and written instructions.
• Must be able to work a flexible schedule.
• Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations.
• Must be able to multi-task and prioritize.
• Must demonstrate extreme attention to detail.
• Must possess strong organization skills.
• Must be able to problem solve and use reasoning.
• Must be able to meet predefined quality standards.
• Must maintain and project a professional attitude and appearance at all time.
• Must have a working knowledge of CPT and ICD-10 coding rules.
• Must have a solid foundation of insurance knowledge and guidelines for third party payers.
• Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology.
• All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance.

Preferred Qualifications:

• Two (2) years’ experience working with an Electronic Medical Record (EMR).
• Medical Billing Certification

Driving/Travel:

The employee must have reliable transportation. While the primary workplace may be closest to the employee’s home, work assignments could be in any of the Company’s locations.

Compensation and Benefits:

• Pay Range: $19.00/hr - $21.00/hr
• PTO: Up to 96 hours in first year (pro-rated based on start date)
• Holidays: 7 (New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, Day After Thanksgiving, Christmas Day)
• Retirement: 401(k) with employer match
• Health Benefits: Medical (single and family), Dental (single and family), Vision (single and family)
• Other Company-Paid Benefits: Short-Term Disability, Long-Term Disability, Basic Life/AD&D, Employee Assistance Program
• Other Voluntary Benefits: Voluntary Life, Accident, Critical Illness, Hospital Indemnity
• Other Compensation: This position is non-exempt (hourly) and eligible for overtime pay in accordance with applicable law. Overtime is not guaranteed. This position is not eligible for bonus, commission, incentive, or shift differential pay.