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    "requisitionDescription": "<div><div><div><p><br></p><p id=\"isPasted\"><strong>Insurance Navigator (Pre-Authorization)</strong></p><p><strong>Department:</strong> Business Development</p><p><strong>Reports To:</strong> Call Center Manager</p><p><strong>Summary:</strong></p><p>The Clinical Patient Navigator assists patients in getting approval for necessary medical services by guiding them through the pre-authorization process. This role uses organizational and communication skills to help patients, work with healthcare providers and insurance companies, and ensure a smooth path to their care. The Clinical Patient Navigator is a key contact for patients needing pre-authorization, offering support and clear information.</p><p><strong>Essential Functions:</strong></p><ul type=\"disc\"><li><strong>Pre-Authorization Support:</strong>&nbsp;<ul type=\"circle\"><li>Help process pre-authorization requests for different medical services like procedures (inpatient, outpatient, same day surgery), tests(all kind of radiology), and medications.</li><li>Understand and follow the rules of different insurance companies for getting approvals.</li><li>Able to navigate and utilized diverse insurance&#39;s portals to obtain and or initiated pre-authorization for specific procedures.</li><li>Enter patient and medical information accurately into computer systems.</li><li>Help gather necessary paperwork from doctor&#39;s offices.</li><li>Follow up on pre-authorization requests to avoid delays.</li><li>Share the results of the pre-authorization with patients and the healthcare team clearly.</li><li>Learn about different insurance plans and their pre-authorization rules.</li></ul></li><li><strong>Patient Guidance:</strong>&nbsp;<ul type=\"circle\"><li>Be a main point of contact for patients with pre-authorization questions, offering friendly support.</li><li>Explain the pre-authorization process to patients and their rights.</li><li>Help patients understand what their insurance might cover and any potential costs.</li><li>Answer patient questions and concerns politely and get help for more complex issues.</li><li>Connect patients, doctors&#39; offices, and insurance companies to help resolve pre-authorization issues.</li></ul></li><li><strong>Teamwork and Communication:</strong>&nbsp;<ul type=\"circle\"><li>Work well with doctors, nurses, and other healthcare staff to get needed medical information.</li><li>Communicate clearly with insurance companies to get timely approvals.</li><li>Work with billing departments to ensure correct processing of claims.</li><li>Participate in team meetings to improve how pre-authorizations are handled.</li></ul></li><li><strong>Record Keeping and Following Rules:</strong>&nbsp;<ul type=\"circle\"><li>Keep accurate and complete records of all pre-authorization work following all guidelines.</li><li>Protect patient privacy according to HIPAA rules.</li><li>Report any possible issues or trends related to pre-authorization.</li></ul></li></ul><p><strong>Qualifications:</strong></p><ul type=\"disc\"><li>High school diploma or equivalent required.</li><li>Associate&#39;s degree in Healthcare Administration or a related field is preferred. &nbsp;</li><li><strong>Experience with medical billing &amp; EMR System a requirement.</strong></li><li><strong>Bilingual in Spanish is a plus.</strong></li><li>Good communication and customer service skills.</li><li>Ability to organize information and pay attention to detail.</li><li>A desire to help patients navigate their healthcare.</li><li>Microsoft suite(Excel, Word, outlook) experience a requirement.</li></ul><p><strong>Physical Requirements:</strong></p><ul type=\"disc\"><li>Requires extensive periods of sitting at a desk.</li><li>Requires frequent and repetitive typing and computer use.</li></ul><p><strong>Working Conditions:</strong></p><ul type=\"disc\"><li>Fast-paced work environment with deadlines.</li></ul><p>&nbsp;</p><p><br></p></div></div></div>\n",
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