Role Description Reporting to and working under the general direction of the Supervisor(s) and Manager of the department, the Specialty Navigator reviews and processes inpatient or outpatient surgical cases. Works with patients and providers to understand services being requested. Works closely with Specialty Nurses to ensure clinical handoffs are safe and appropriate. Schedule (FT, 38.75 hours/week): Monday – Friday 8:30am – 5pm EST or 8:00am – 4:30pm EST. If you reside within the state of Massachusetts, you will enjoy the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: - Reviews referral information from clinicians for pertinent information regarding surgeries. - Verifies demographics and insurance information. - Work is highly complex and detail oriented, involving frequent contact with a range of internal and external contacts as well as the need to understand terms and processes of multiple payers. - Ensures adequate information is obtained and relayed when care is moved. - Explains insurance benefits and options to patients. - Explains denials to patients and keeps them informed of the status of all referrals (approved and denied). - Notifies patients of scheduled appointments and confirms appointments by mail including confirmed location and map of destination. - Informs patients of any preparation that must be completed prior to the appointment. - Contacts patients if insurance coverage issues arise during the referral process so that patients can work directly with the insurance company. - Promotes the Reliant and Atrius Health System of Care by highlighting internal providers and their expertise. - Answers phone calls, faxed requests and other inquiries relating to referrals and communicates with the physicians and clinicians to acquire authorization or to inform them of patient issues or clinical paperwork needed. - Researches questions/concerns from patients regarding bills and determines if the issue is related to the referral process. - Assists in resolving billing and denied referral matters as they relate to the referral process. - Refers patients to appropriate staff (e.g., patient account representatives) for billing issues related to insurance benefits and services covered under the benefits plan. - Works in collaboration with the person designated as the Practice’s Benefits Coordinator to maintain cost control, ensure that services provided are within benefit plan guidelines, and that necessary policies and procedures are followed when dealing with non-preferred providers/vendors. - Works with supervisors to ensure patients are receiving timely responses and detailed answers to their complex questions. - Receives escalated issues and same day calls; determines appropriate action and/or works with clinical team for decision. - Effectively deescalates issues with upset patients and practices. Uses advanced listening techniques to understand the issue and give patients options as they are available. Escalates to supervisors only as needed. - Supports roles within the Navigator. - Trains and teaches as needed. - Participates in problem solving activities, focusing on productivity and quality. - Works with supervisors to ensure continuous improvement of the department. - If needed, contacts appropriate parties to obtain referral authorizations and verify coverage (e.g., the Authorization Services Unit (ASU), National Imaging Associates (NIA) or individual insurance companies). - Certain departments may also need to contact additional outside agencies for approval (e.g., American Imaging Management or Med Solutions). Qualifications - High School Diploma/GED. - 1+ years of receptionist, admin support, or healthcare-related experience. - Experience with Medical Terminology and CPT Codes. - Intermediate level of proficiency with MS Office tools. - Must reside in Massachusetts. Requirements - 1+ years of experience working in a medical office position performing duties such as scheduling appointments, checking patients in/out, insurance verification, collecting co-pays and maintaining medical records. - Proficiency in Microsoft Office (Word, Excel and Outlook). - Knowledge of Epic EMR software. - Ability to learn new software (EPIC/EMR) and flexibility to attend new hire training. Benefits - Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays. - Medical Plan options along with participation in a Health Spending Account or a Health Saving account. - Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage. - 401(k) Savings Plan, Employee Stock Purchase Plan. - Education Reimbursement. - Employee Discounts. - Employee Assistance Program. - Employee Referral Bonus Program. - Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).