Patient Navigator II

🔥 25 minutes ago

🏖️ New Jersey, Maryland – Remote

🏖️ New Jersey – Remote 🦀 Maryland – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Clearway Pain Solutions

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

🧘 Wellness

💊 Pharmaceuticals

Healthcare • Wellness • Pharmaceuticals

Clearway Pain Solutions is a healthcare organization dedicated to providing comprehensive pain management services. With locations across several states, including Texas, the company focuses on relieving chronic pain, restoring physical function, and enhancing the quality of life for its patients. Clearway employs a multi-disciplinary approach to treatment, offering interventional pain management, physical therapy, and medication management, ensuring that patients receive tailored care that meets their unique needs.

📋 Description

• Manage complex procedures, high-end ASC cases, first-level escalations, and eligibility exceptions • Serve as the senior operational liaison across scheduling, eligibility, providers, and operations • Conduct mandatory introductory calls to patients for assigned procedures and additional calls as needed • Serve as the onshore liaison to the offshore eligibility and pre-certification team • Review eligibility and authorization findings, clarify discrepancies, and resolve escalations • Re-verify eligibility and benefits when discrepancies are identified before scheduling • Provide eligibility confirmation support for payer conflicts, discrepancies, and escalations • Support same-day, emergency, and Medicare add-on procedures requiring rapid validation • Communicate authorization status and timelines • Explain out-of-pocket costs and collect deposits • Finalize scheduling once procedures are cleared • Identify potential escalations or patient fallout • Document communications and escalate issues according to policy • Serve as the primary point of contact for initial patient fallout • Conduct first-level retention conversations, address insurance/cost/process questions, and provide education and reassurance • Coordinate handoffs to the Office Manager, Vice President of Operations, or clinical team when patients elect not to proceed • Maintain confidentiality and comply with HIPAA rules and regulations • Check and respond to work email regularly throughout the workday • Complete required training and in-services • Perform other duties as assigned

🎯 Requirements

• High School Diploma or equivalent with a minimum of three (3) years related experience; or an equivalent combination of education and/or experience • Knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook) • Prior experience making outbound calls using VOIP software • Excellent written and oral communication skills, including exceptional customer service • Ability to establish and maintain effective working relationships with doctors, clinical staff, co-workers, and the public • Ability to work individually and within a team • Ability to follow verbal and written instructions • Ability to work a flexible schedule • Ability to respond with patience and understanding during stressful conditions related to patient health and emergent situations • Ability to multitask and prioritize • Extreme attention to detail • Strong organizational skills • Problem-solving and reasoning abilities • Ability to meet predefined quality standards • Professional attitude and appearance • Working knowledge of CPT and ICD-10 coding rules • Solid foundation of insurance knowledge and third-party payer guidelines • Working knowledge of the healthcare field and medical specialty • Knowledge of medical terminology • Reliable transportation • Preferred: Two (2) years’ experience working with an Electronic Medical Record (EMR) • Preferred: Medical Billing Certification

🏖️ Benefits

• Flexible schedule • Required trainings and in-services • Remote work option within Maryland or New Jersey