AdvantageCare Physicians (ACPNY)

  • Patient Navigator

    ID
    2018-5513
    Office Name
    55 Water St.
    Type
    Full Time
    City
    New York
    Union / Non-Union
    Non-Union
    Primary Location
    US-New York
    Daily Schedule
    8am-5pm
    Dept/Spec
    Billing and Collections [71320]
  • Overview

    AdvantageCare Physicians is the largest physician led outpatient medical office in the New York Metropolitan Area. With 36 medical offices in the Brooklyn, Long Island, Manhattan, Queens and Staten Island, we aspire to be the preferred care destination for our patients and the communities we serve. This vision is accomplished through focusing our care on the needs of our patients as we partner with them in the pursuit of better health.  Each and every day, our actions should be guided by these principles as we interact with our patients, each other and our communities. The values that drive the AdvantageCare Physicians culture include a caring attitude, quality focus, collaboration, excellence and good citizenship. By integrating these behaviors into our day-to-day operations, we can deliver the highest quality healthcare while also creating positive patient experiences.

     

    The Patient Navigator is responsible for making the patient experience smoother through coordination and processing of all patient referrals. They are responsible for claims charge review edits related to the referrals, following protocols for proper authorization and processing of all referrals.

    Responsibilities

    • Coordinates complex referral authorization requests and determines course of action based on plan guidelines. Consults with Patient Access Manager when appropriate.
    • Follows AdvantageCare Physicians protocols and standing orders for proper authorization and processing of all referrals and completes all administration functions associated with referral activities in a timely manner. Recommends enhanced workflows for referral management.
    • Responsible for monitoring all referral reports not received and timely follow-up in accordance with AdvantageCare Physicians policy and procedure. Recommends enhanced workflows to reduce referral errors and improve referral workflow.
    • Monitors daily work queues and work lists generated from Care Team Associate I's and call teams ensuring compliant referral processing and escalating any issues as appropriate to the manager. Recommends enhanced workflows to reduce referral errors and improve referral workflow.
    • Acts as liaison between and advocate for patients. Addresses patient inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Explains policies and procedures to patients and refers them to the proper services required.
    • Coordinates payor and group financial negotiations for out of network referrals following AdvantageCare Physicians, New York State, and payor guidelines for ensuring compliant referral processing.
    • Performs other job-related duties as required.

    Qualifications

    • High School diploma or General Equivalency Diploma required
    • Bachelor’s Degree in related field preferred
    • Minimum of one year of direct experience involving insurance verification, pre authorizations and other patient access functions required.
    • Experience coordinating referral authorizations required

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