Patient Account Navigator-Main Infusion Center-WFH - Hillcrest - Tulsa

General Description: Initiates and coordinates insurance or other carrier pre-certification and prior authorization for patients. Provides financial counseling to patients. Coordinates with the business office to ensure timely claim and account follow-up.

Essential Responsibilities:

• Pre-Certification: Completes the pre-certification process communicating with the patient, physician, insurance company, other financial institutions and the hospital.
• Information: Interviews patient by telephone or in person to gather financial information in order to determine discounts that may be applicable.
• Payment Options: Explains financial responsibilities for services received and payment options to patients and/or insurance or other financial institutes responsible for payment.
• Counseling: Counsels patients regarding insurance benefits and recommends alternative sources of payment and financial assistance when appropriate. Reviews provider and treatment protocols, determines insurance benefits and patient responsibility, establish payment arrangements with the patient, and documents appropriate practice management system.
• Advocate: Acts as an advocate for the patient when discussing medical care with the insurance carrier or other financial institute.
• Correspondence: Prepares medical necessity letters for the insurance companies and other financial institutes.
• Processing: Receives and processes information and forms from the patient and insurance company.
• Prescriptions: Assists patients with obtaining financial resources for oral medication prescriptions by working with pharmaceutical companies and other resources to obtain grants and financial aid for patients in need.
• Scheduling: Obtain prior authorizations from insurance to schedule patient scans and specialty clinic referrals.

• Performs other duties as assigned.

Minimum Requirements:

Education: High school diploma or GED required.

Experience: 12 months experience in pre-certifications, customer service, medical billing, accounts receivable or related experience required. Medical terminology or medical insurance experience preferred.

OR: Equivalent combination of education and experience.

Licensure/Certifications/Registrations Required: None.

Knowledge, Skills, & Abilities:

• Basic knowledge of HIPAA regulations and procedures.
• Excellent verbal and written communication skills.
• Must be detail oriented.
• Ability to multitask and meet deadlines.
• Ability to read and interpret basic business correspondence, safety manuals and policy manuals.