Uniontown Primary Care Clinics-Patient Navigator

WVU Medicine Uniontown Hospital; Pennsylvania; On-site; USD 60,000 - 85,000; Full time

Job summary

WVU Medicine Uniontown Hospital seeks a qualified professional to establish patient relationships and act as a primary contact for payor coordination. The role involves analyzing market data to identify payor populations, verifying insurance benefits, and ensuring coverage for obesity treatment where applicable.

The position requires 3 years in healthcare with at least 1 year in statistical data analysis, strong interpersonal and negotiation skills, and proficiency in Microsoft Office.

Qualifications

• Bachelor’s degree in Healthcare Management, Public Health, or related field OR;
• Associate’s degree in Healthcare Management, Public Health or related field AND two (2) years of experience directly related to the duties and responsibilities specified. OR;
• High school diploma or equivalent AND (4) years of experience directly related to the duties and responsibilities specified.

Responsibilities

• Establishes close relationships with and serves as primary point of contact for patients.
• Strategizes to help find payor population based on regional payer mix by collecting and analyzing market data.
• Responsible for verifying insurance benefits and ensuring coverage for obesity treatment for patients.
• Maintain a working knowledge of insurance payors pre-certification requirements for medications, diagnostic testing, surgery, referrals, etc.
• Proactively review policies for changes to prevent delays in certification where applicable.
• Educates providers and staff on payor regulations in order to prevent denials.
• Removes barriers to care by identifying resources for patients and helping them navigate through healthcare services.
• Works with different service lines to assure coordination of appointments if applicable.
• Schedules patient appointments and adjusts as needed, coordinating with labs and tests, reminders, and wait-lists.
• R rounds on assigned patients daily and assists with scheduling discharge appointments.
• Assists with getting prescriptions filled and assesses costs and availability.
• Documents patient information and obtains outside records as needed.
• Engages family and community resources to meet emotional, social, and financial needs of the patient.
• Collaborates with social services for resource and financial management including entitlement programs and referrals.
• Other department duties may be assigned.
• Travel to all WVU Medicine Uniontown Primary Care Clinics.

Skills

Interpersonal communication

Negotiation

Microsoft Office

Education

Bachelor’s degree in Healthcare Management or Public Health

Associate’s degree with 2 years experience

High school diploma with 4 years experience

Tools

Microsoft Office

Job description

Welcome! We’re excited you’re considering an opportunity with us! Below, you’ll find other important information about this position.

Minimum Qualifications

• Bachelor’s degree in Healthcare Management, Public Health, or other related field OR;
• Associate’s degree in Healthcare Management, Public Health or other related field AND two (2) years of experience directly related to the duties and responsibilities specified. OR;
• High school diploma or equivalent AND (4) years of experience directly related to the duties and responsibilities specified.

Preferred Qualifications

• Bachelor’s degree in Healthcare Management or Public Health.

Experience

• Three (3) years’ experience in the healthcare field. One (1) year of experience in statistical data analysis.

CORE DUTIES AND RESPONSIBILITIES

• Establishes close relationships with and serves as primary point of contact for patients.
• Strategizes to help find payor population based on regional payer mix by collecting and analyzing market data. Responsible for verifying insurance benefits and ensuring coverage for obesity treatment for patients.
• Maintain a working knowledge of insurance payors pre-certification requirements for medications, diagnostic testing, surgery, referrals, etc. Proactively review policies for changes to prevent delays in certification where applicable.
• Educates providers and staff on payor regulations in order to prevent denials.
• Removes barriers to care by identifying resources for patients and helping them navigate through healthcare services.
• Works with different service lines to assure coordination of appointments if applicable.
• Schedules patient appointments and adjusts as needed. This includes coordinating appointments with laboratory or diagnostic testing, ensuring adherence to appointments, reminder calls, and managing the patient wait-list.
• Will be aware if one of their assigned patients is admitted and will round on them daily / assists with scheduling discharge appointments.
• Assists with getting prescriptions filled. Assesses cost, availability etc.
• Documents patient information and obtains outside records, as needed.
• Engages family and/or community resources to meet the identified emotional, social, and financial needs of the patient.
• Collaborates with available social services for appropriate resource and financial management which may include, but is not limited to, financial assistance coordination and referrals, entitlement program coordination and referrals, patient benefit coordination, assessment for appropriate usage of healthcare resources, and clinical cost efficiency.
• Other department specific duties may be assigned.

PHYSICAL REQUIREMENTS

• Ability to sit for extended periods of time.

WORKING ENVIRONMENT

• Standard office/clinical environment.

Skills And Abilities

• Possesses excellent interpersonal communication and negotiations skills in interactions with patients, families, providers, and healthcare team colleagues.
• Ability to work with people of all social, economic, and cultural backgrounds and be flexible, open-minded, and adaptable to change.
• Proficient in Microsoft Office.

Additional Job Description

• Schedules patients for AWV, runs quality reports for all providers, collaborates with clinic/office staff as well with physicians and APPs to improve quality benchmarks.
• Collaborates to perform outreach and assist in management of patients with many complex and co-morbid conditions
• Educates and counsel patients concerning pertinent information for the medical condition. Prepares educational materials for patient use.
• Contacts medical insurance companies to provide comprehensive medical information in order to obtain authorization.
• Ensures all necessary testing and scheduling is complete prior to necessary procedures. Provides follow up to such.
• Works in conjunction with health service coordinators to achieve all necessary prior pre-authorization and that all testing is scheduled.
• Provides assistance in quality, education, and research efforts.
• Perform in office testing; DRE exams, lab draws, urine collection, POCT testing, rooming, etc as needed per operations.
• Travel to all of our WVU Medicine Uniontown Primary Care Clinics.

Scheduled Weekly Hours

40

Exempt/Non-Exempt

United States of America (Non-Exempt)

Company

UNTWN Uniontown Hospital

Cost Center

506 UNTWN Unassigned

Address

109 Crossroads Road

Scottsdale

Pennsylvania

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.