Under the general supervision of Access Business Services management, Clinical Access Navigator serves as a liaison between Cooper providers and business operations, and insurance payors via the web and telephonically to provide clinical information necessary to secure prior authorizations for patient services.
Contacts insurance payors in response to “peer-to-peer requests.”
Gathers and submits necessary documentation required to successfully obtain prior authorization or pre-certification for patient services.
Manages and documents patient and payor phone calls pertaining to medical conditions, prior authorizations and any questions according to established department routine. Provides clear and accurate documentation in the system for all actions taken as well as outcomes.
Works with ABS Insurance Specialists, ordering physician offices and staff, patients and patient families to resolve questions or issues concerning prior authorizations. Responds appropriately within skill level and documented departmental policies and when appropriate.
Follows through in a timely manner on payor and patient calls/requests. Handles all calls using ABS Telephone Scripting and QA Telephone Expectations. Understands and utilizes features of the telephone and voice mail system (i.e. hold, transfer, forward, creation of changing of phone mail greetings, etc.)
Maintains ABS departmental quality and productivity standards. Assists in the development, revision and maintenance of payor prior authorization protocols for staff and providers.
Efficiently operates computer, copier, fax machine, telephone system and performs numerous other clerical and technical duties in accordance with current procedures.
Maintains and utilizes knowledge of all departmental clinical resources.
This position will serve as a key resource to patients.
Scheduled Days / Hours: M-F; License (or Certification):BLS Required; License (or Certification):NJ-LPN Required
Graduate of an acrredited school of practical nursing
Minimum two years of general ambulatory office experience.
Working knowledge of medical insurance plans & products, coordination of benefits guidelines, and requirements for authorizations and pre-certifications preferred.
Experience with securing prior authorizations for services from third party payors preferred.
Proficiency in working with payor online portals, as well as NaviNet, Passport or other third party eligibility systems preferred.
Experience in resolving peer-to-peer review requests from insurance payors preferred.
Proficiency in EPIC preferred.
Current New Jersey LPN License (Licensed Practical Nurse).
BLS Certification (Healthcare Provider Course)
Excellent verbal and written communication skills.
Skilled in use of computers and software applications, i.e., Microsoft Word, Excel, Outlook.
Analytical ability, good interpersonal staff skills, self starter who needs little supervision.
Knowledge of electronic medical records.
Ability to organize, take independent action and project Cooper values to customers and co-workers.