Clinical Review Navigator (PCMA Team) - 24 Hours per Week - Days - Remote
Henry Ford Health, Troy, MI, United States
Overview
Reports to Patient Billing and Financial Care Assistance (PBFCA) Leadership. Under minimal supervision, this position assists the Clinical Review Team in screening uninsured, under-insured, and insured patient care requests for medical necessity and urgency, and ensures that all financial responsibilities (current and prior balances) are addressed before services are rendered. Advises patients of available financial assistance programs and collaborates with physicians and other Henry Ford Health staff across all organizational levels to determine continuing care needs.
Principle Duties And Responsibilities
Identifies patients with inadequate access to resources, including health insurance coverage, primary care services and medications, and provides referrals to affordable community-based resources as appropriate.
Manages the team\'s EPIC work queues to ensure that all financial responsibilities are addressed before services are scheduled and/or rendered.
Manages the team\'s EPIC Department Appointment Report (DAR); documents all cases and follows to completion.
Conducts the initial review of care requests of uninsured and under-insured patients for financial assistance based on approved criteria; prepares complex patient care requests for second and third level reviews by the Clinical Review Leader team for medical necessity and urgency.
Accurately registers and schedules appointments for approved patients based on the Clinical Review Team’s determination and scheduling protocols.
Handles all incoming telephone activity, including answering phones promptly according to system quality standards; documents all interactions thoroughly, accurately, and legibly; takes accountability for cases through completion.
Identifies actual and potential problems with HFHS financial assistance programs, complex ambulatory HB & PB billing and denials, and improves the patient care process and utilization of outpatient resources through the appropriate action and/or recommendation.
Assists patients with Medicare, Medicaid, Medicaid HMO, Marketplace and Commercial insurance enrollment, including assessing the patient\'s financial needs to determine the best plan.
Investigates and assists patients with internal and external financial assistance programs, including Henry Ford Health Patient Financial Assistance Program applications, resources for care, Cobra payments, drug assistance, transportation, and collaborating with other HFH teams to prevent financial toxicity to the patient.
Investigates insurance plan authorization requirements and obtains required authorizations for ambulatory outpatient services when necessary.
Processes and reviews incoming Community Partner Referral (CPR) program voucher requests for ambulatory specialty services, ensuring they meet the qualifications of this uncompensated charity program.
Monitors and reviews CPR and CPR Lab only billed services for accuracy.
Collaborates with CPR program Federally Qualified Health Clinic partners in the community.
Maintains strict confidentiality standards for patient information. Complies with organizational, federal, and state regulations and policies on confidentiality.
Performs other related duties as required.
Qualifications
High School Diploma or G.E.D. equivalent.
Associate's degree or two (2) years of college coursework in business, community health, social work, case management or a related field, preferred.
Two (2) years of experience working as a patient navigator, patient advocate, financial navigator or insurance verification specialist. Working knowledge of Microsoft Office Suite.
Technical proficiency in EPIC applications such as Appointment Scheduling (all versions), Registrations, Work Queues and Referrals.
Knowledge of medical terminology preferred.
Bilingual, as appropriate to the work site. Ability to speak clearly and effectively.
Customer service-oriented, including the ability to interact professionally and handle sensitive information/issues in a confidential, respectful, assertive, and empathetic manner in difficult interpersonal situations.
Ability to act in a manner that establishes positive rapport with patients, families, and public/private financial assistance programs.
Ability to quickly assess and respond appropriately to emergency situations.
Ability to comprehend medical terms; analytical skills to resolve complex problems requiring scientific, mathematical, or technical principles; multi-tasking experience.
Ability to deliver consistent results and drive to continually improve processes to benefit the patient and the hospital system.
Ability to visually proofread typed work for errors.
Ability to communicate via telephone to a variety of groups (patients, patients\' families, insurance companies, other departments, etc.).
Additional Information
Organization: Corporate Services
Department: Ascension Ambulatory Ops
Shift: Day Job
Union Code: Not Applicable
#J-18808-Ljbffr
Reports to Patient Billing and Financial Care Assistance (PBFCA) Leadership. Under minimal supervision, this position assists the Clinical Review Team in screening uninsured, under-insured, and insured patient care requests for medical necessity and urgency, and ensures that all financial responsibilities (current and prior balances) are addressed before services are rendered. Advises patients of available financial assistance programs and collaborates with physicians and other Henry Ford Health staff across all organizational levels to determine continuing care needs.
Principle Duties And Responsibilities
Identifies patients with inadequate access to resources, including health insurance coverage, primary care services and medications, and provides referrals to affordable community-based resources as appropriate.
Manages the team\'s EPIC work queues to ensure that all financial responsibilities are addressed before services are scheduled and/or rendered.
Manages the team\'s EPIC Department Appointment Report (DAR); documents all cases and follows to completion.
Conducts the initial review of care requests of uninsured and under-insured patients for financial assistance based on approved criteria; prepares complex patient care requests for second and third level reviews by the Clinical Review Leader team for medical necessity and urgency.
Accurately registers and schedules appointments for approved patients based on the Clinical Review Team’s determination and scheduling protocols.
Handles all incoming telephone activity, including answering phones promptly according to system quality standards; documents all interactions thoroughly, accurately, and legibly; takes accountability for cases through completion.
Identifies actual and potential problems with HFHS financial assistance programs, complex ambulatory HB & PB billing and denials, and improves the patient care process and utilization of outpatient resources through the appropriate action and/or recommendation.
Assists patients with Medicare, Medicaid, Medicaid HMO, Marketplace and Commercial insurance enrollment, including assessing the patient\'s financial needs to determine the best plan.
Investigates and assists patients with internal and external financial assistance programs, including Henry Ford Health Patient Financial Assistance Program applications, resources for care, Cobra payments, drug assistance, transportation, and collaborating with other HFH teams to prevent financial toxicity to the patient.
Investigates insurance plan authorization requirements and obtains required authorizations for ambulatory outpatient services when necessary.
Processes and reviews incoming Community Partner Referral (CPR) program voucher requests for ambulatory specialty services, ensuring they meet the qualifications of this uncompensated charity program.
Monitors and reviews CPR and CPR Lab only billed services for accuracy.
Collaborates with CPR program Federally Qualified Health Clinic partners in the community.
Maintains strict confidentiality standards for patient information. Complies with organizational, federal, and state regulations and policies on confidentiality.
Performs other related duties as required.
Qualifications
High School Diploma or G.E.D. equivalent.
Associate's degree or two (2) years of college coursework in business, community health, social work, case management or a related field, preferred.
Two (2) years of experience working as a patient navigator, patient advocate, financial navigator or insurance verification specialist. Working knowledge of Microsoft Office Suite.
Technical proficiency in EPIC applications such as Appointment Scheduling (all versions), Registrations, Work Queues and Referrals.
Knowledge of medical terminology preferred.
Bilingual, as appropriate to the work site. Ability to speak clearly and effectively.
Customer service-oriented, including the ability to interact professionally and handle sensitive information/issues in a confidential, respectful, assertive, and empathetic manner in difficult interpersonal situations.
Ability to act in a manner that establishes positive rapport with patients, families, and public/private financial assistance programs.
Ability to quickly assess and respond appropriately to emergency situations.
Ability to comprehend medical terms; analytical skills to resolve complex problems requiring scientific, mathematical, or technical principles; multi-tasking experience.
Ability to deliver consistent results and drive to continually improve processes to benefit the patient and the hospital system.
Ability to visually proofread typed work for errors.
Ability to communicate via telephone to a variety of groups (patients, patients\' families, insurance companies, other departments, etc.).
Additional Information
Organization: Corporate Services
Department: Ascension Ambulatory Ops
Shift: Day Job
Union Code: Not Applicable
#J-18808-Ljbffr