Patient Navigator - Adult Cystic Fibrosis Program

Summary

The Adult Cystic Fibrosis (CF) at National Jewish is the largest CF center in the nation. Our CF center has been recognized nationally and internationally for the work our practitioner and researcher have contributed to this field of medicine.

The patient navigator is the first point of contact for our patients, this position represents the face of The National Jewish Health Adult Cystic Fibrosis Center.  They will collaborate with physicians and staff to ensure an outstanding patient experience.

 As the leading respiratory hospital in the nation, National Jewish Health is pioneering a new era of preventive and personalized medicine. By combining our efforts in comprehensive care, academic education and ground-breaking research, we're able to develop treatments that help our patients live more productive lives. If you believe in Science Transforming Life, we invite you to join our team.

Position Summary
Collaborates with management to train and guide new and current employees in the Patient Finance Office. Assists Financial Counseling Supervisor with escalated patient issues and more complicated patient situations as needed. Evaluates patient’s potential financial liability prior to and after medical services have been rendered.  This includes working with patients and their families to evaluate financial data and determine ability to pay under all payors, negotiating payment arrangements and administering hospital and state financial assistance programs.

Essential Duties

1. Leads the work of coworkers by providing direction, guidance, training, and resources as appropriate. Identifies training needs for the Patient Finance Office staff and schedules appropriate training sessions. Prepares or obtains training materials. Communicates with management and co-workers when new information/ knowledge on a topic that is beneficial to the team.
2. Submits billing to pharmaceutical copay assistance programs for reimbursement of claims. Assists patients with applying for copay assistance and answers questions as needed. Works with pharmaceutical representatives and companies to establish the correct processes necessary for reimbursement. 
3. Available to meet with patients, scheduled and unscheduled, in the Patient Finance Office.  Directs patients to appropriate departments as needed.  Answers a multitude of questions regarding billing, financial impacts, benefits, referrals, authorization, services, estimates, etc., as well as addressing concerns and complaints.  
4. Evaluates and communicates patient’s potential financial liability directly to the patient prior to medical services being rendered based on insurance verification data and medical cost estimates.  Negotiates collection deposits of estimated co-insurance, co-pay and deductible amounts.
5. Provides financial counseling by telephone, electronic/standard mail or face-to-face to patients/guarantors to ensure collectability of patient balances and/or accounts in compliance with federal and state laws regarding debt collection and hospital billing and collection policies.  This includes securing patient payments by negotiating payment plans or arranging alternative settlement agreements.  
6. Administers hospital financial assistance policies and the Colorado Indigent Care Program (CICP).  Audits and adjusts all charity accounts monthly.  Interprets individual, self-employed and business financial statements to accurately rate a patient using the guidelines of the charitable programs.
7. Evaluates patient financial applications for Colorado Medicaid eligibility.  Assists patients with Colorado Medicaid application process.
8. Maintains ability to read and comprehend all payors’ claims adjudication vouchers.  Utilizes vouchers in order to perform comprehensive account audits as necessary on self-pay balance disputes, processing of patient refunds, payment transfers and adjustments in accordance with PBO policy.  
9. Handles all patient questions and concerns with regard to the processing of patient insurance claims and financial assistance eligibility.  Performs self-pay and bad debt collection follow-up as assigned and in accordance with PFS policy.
10. Serve as the PFS Customer Service Representative to the Patient Financial Services Department.  Providing excellent customer service to patients, co-workers, and clinical staff.  Greets customers on the telephone or in person, assesses needs and provides information and /or services requested.  Directs patients to appropriate departments as needed. 
11. Performs Insurance verifications.  Includes obtaining and documenting covered and non-covered benefits, plan type, copayments, co-insurance, out of pocket, and deductible amounts and determining contract and benefit eligibility. Contact insurance companies as needed.  
12. Reviews and may complete authorizations and referral requests.  Communicates with utilization management department as necessary to ensure that services are authorized.  
13. Maintains a current and thorough working knowledge of third party payors processing in regards to medical management policy, provider contractual obligations, patient benefit levels, and payor specific insurance terminology.
14. Maintains appropriate level of knowledge regarding NJH clinical operations.

Other Duties

1. Maintains appropriate level of expertise with the HIS, EMR, eligibility software, scheduling software, scanning software, merchant software, and vendor systems.     
2. Communicates regularly with Supervisor or Manager regarding high-risk accounts.  Identifies and refers problematic workflow trends to Supervisor for evaluation and solution.  
3. Provides supervisor with weekly productivity statistics and reports workload fluctuations (backlog or shortages) in a timely manner.

Competencies

1. Accountability: Accepts full responsibility for self and contribution as a team member; displays honesty and truthfulness; confronts problems quickly; displays a strong commitment to organizational success and inspires others to commit to goals; demonstrates a commitment to National Jewish Health. 
2. Adaptability: Maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements, or cultures.
3. Building Trust: Interacting with others in a way that gives them confidence in one’s intentions and those of the organization.
4. Coaching and Teaching Others: Providing timely guidance and feedback to help others strengthen specific knowledge/skill areas needed to accomplish a task or solve a problem.
5. Collaboration/Teamwork: Cooperates with others to accomplish common goals; works with employees within and across his/her department to achieve shared goals; treats others with dignity and respect and maintains a friendly demeanor; values the contributions of others.
6. Customer Focus: Ensuring that the customer perspective is a driving force behind business decisions and activities; crafting and implementing service practices that meet customers’ and own organization’s needs.
7. Initiative: Taking prompt action to accomplish objectives; taking action to achieve goals beyond what is required; being proactive.
8. Attention to Detail: Accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time. Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed.

Supervisory or Managerial Responsibility
Leads the tasks of co-workers.

Travel
None

Core Values

1. Be available to work as scheduled and report to work on time.
2. Be willing to accept supervision and work well with others.
3. Be well groomed, appropriately for your role and wear ID Badge visibly.
4. Be in compliance with all departmental and institutional policies, the Employee Handbook, Code of Conduct and completes NetLearning by due date annually.
5. Fosters an inclusive workplace where diversity and individual differences are valued and leveraged to achieve the vision and mission of the institution.
6. Adheres to safe working practices and at all times follows all institutional and departmental safety policies and procedures. 
7. Wears appropriate PPE as outlined by the infection control policies and procedures.
8. Demonstrates compliance with all state, federal and all other regulatory agency requirements.

Minimum Qualifications

1. Education: High school diploma or equivalent required. Associate’s degree preferred. 
2. Work Experience: A minimum of 3 years experience in financial counseling, patient financial services or insurance billing in a healthcare or health insurance environment in any aspect of the revenue cycle process required.
3. Special Training, Certification or Licensure: None

Salary Range: $18.00 - $22.00

Benefits
At National Jewish Health, we recognize that our outstanding faculty and staff are the essence of our organization. For every aspect of health care, our employees are our greatest asset.
With that in mind, we have designed a valuable, comprehensive benefits package to meet the needs of our employees and their families.

• Medical Plans, Dental Plans and Vision Insurance
• Retirement Plan
• FSA and HSA
• Short and Long Term Disability
• Life Insurance and AD&D
• Voluntary Benefits, like Accident Insurance, Critical Care and Hospital Indemnity
• Sick and Vacation Paid Time Off
• Wellness Program
• Legal Plan