Patient Navigator 2

JOB SUMMARY

Provide a description of the overall purpose of the position. “Why does this position exist?”

State the general nature, level and purpose of the job and a brief description of the duties and responsibilities. It may be easier to write the general summary after completing other sections of the job description.

 

Reports to the  Business Manager, and is guided by the procedures of Inpatient and Outpatient services, the Registration is responsible for providing support to all intensive (Inpatient, Partial Hospitalization, Intensive Outpatient Program, consult Liaison and Electroconvulsive Therapy) patients seeking services at Langley Porter Psychiatric Hospital- UCSF Health. The Registration  is responsible for reception, registration, insurance coverage verification, relaying financial information, providing financial need applications, and patient processing. Along with supporting the Utilization Review Coordinator with analyzing patient records to determine legitimacy of admission, length of stay, and compliance with insurance reimbursement. Receives assignments in the form of objectives with goals and the processes by which to attain them. Serves as a clinical resource and liaison for patients and their families and assists with navigating all aspects of the healthcare system. 

DUTIES & ESSENTIAL JOB FUNCTIONS

                                                                                                                                                

%  

of time

Essential Function (Yes/No)

  

Key Responsibilities

(To be completed by Supervisor)

60 

Patient Navigation and Processing 

• Communicates LPPHC administrative and financial policies clearly to patients, answering patient account questions and knowing when to refer patients to financial counseling, billing partners, patient relations or other support departments for additional help.

• Understands how to identify and interpret a patient’s insurance benefit package, including pharmacy and mental health carve outs.

• Address patient complaints from patients regarding billing and complaints related to billing that come out of Patient Relations.

• Understands the concept of managed care and is knowledgeable about the resources available to the staff in regard to knowing the specific requirements of individual managed care plans. Assist patients to understand the concept of managed care.

• Managed front desk inquiries—both face-to-face and via telephone—while accurately addressing patient questions regarding insurance benefits and coverage. 

• Obtains and documents insurance authorizations for established patient visits, referrals and procedures or ancillary services. Communicates clinical information from medical records authorization requests to insurance companies.

• Works work queues to secure estimate letters and information for accurate billing submissions or to respond to denials such as retro authorizations, clinical documentation, and addended authorizations with add on CPT codes.

• Secures prior authorization for procedures, specialty visits and ancillary testing and coordinates with Hospital Admissions Department as needed.

• Collects and verifies insurance and referral/authorization information for appointments ensuring referral records and Hospital Accounts Records (HARS) are created and assigned to the appointment.

• Secures complex insurance authorizations for services, and is able to track the authorizations for renewal based on insurance company driven limits of time frames or numbers of visits or services.

• Other Duties as assigned.

10

 

Patient Information inptatient Coordination 

• Manages patient expectations by providing Mental Health -specific insurance QOB guidelines related to service/visit. 

• Obtains appropriate consents, PAFRs and signed documents at first visit 

• Creates a professional and positive fi