Patient Navigator

At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives.

The Patient Navigator is responsible for providing exceptional customer services that include case coordination to patients and healthcare practitioners (HCPs) and their staff. This person will be a member of a large team, dedicated to supporting a high-volume call environment within a team environment. The Patient Navigator will provide education to patients or caregivers on the enrollment process, status inquiries and confirm scheduled deliveries of prescribed therapies from specialty pharmacies.

To support the patient journey, the Patient Navigator will be interacting with Pharmacy Benefit Managers (PBMs) Payers (Insurers), customers (patients and healthcare providers) to gather patient information and confirm reimbursement coverage.

• Provide subject matter expertise of program requirements and reimbursement status while maintaining a high level of customer service, having a sense of urgency, being reliable, error free data entry skills, utilizing active listening skills while maintaining proper phone etiquette, utilizing great verbal and writing skills, and maintaining teamwork spirit
• Single point of contact and voice for patients. Works as a patient advocate and always demonstrates compassion
• Performs reimbursement related activities, such as benefit investigations, to providers and/or patients
• Provide exceptional customer service to internal and external customers; resolve customer requests in a timely and accurate manner; elevate complaints according to defined SOPs
• Maintain frequent phone contact with patients, third party customer service representatives and pharmacy staff
• Validates completeness of all required information within case notes based on documentation or communications received from calls, providing notification of any urgent orders, shipping related issues and any errors, complaints or adverse drug events to the appropriate 3rd party or system
• Reports on all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP)
• Extensive knowledge of HIPAA regulations and follows all company policies
• Meet performance standards in alignment with predefined metrics or KPIs
• Typically receives little instruction on day-to-day work and general instructions on new assignments
• Ability to be flexible and maintain composure as duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

• High School Diploma or GED required. Associate or College Degree Preferred
• Experience working in a high-volume call center is required
  • Previous experience working in a pharmacy, healthcare office, or healthcare insurance provider is highly desirable
• Thorough understanding or working knowledge of commercial and major medical insurance programs, billing requirements,
• healthcare benefit investigation processes, prior authorization and appeal filings

Skills
:

• Knowledge of private payers, pharmacy benefits, medical benefits, Medicare Part D, Medicaid and alternate funding resources
  • Demonstrated organization and problem-solving skills to handle patient conversations identify issues and address needs
• Must have comfort level multi-processing across multiple applications concurrently while capturing case information
  • Proficient with Microsoft Office Program Suite and Lotus Notes Suite including Excel, Word, Outlook and Share Point
• Ability to maintain professional communication skills and an understanding of how to maintain a courteous attitude toward customers and fellow employees
• Requires critical thinking skills, analytical skills and the ability to work with minimal supervision. Requires strong communication (verbal and written, clear and concise), customer service and interpersonal skills
• Must be able to take…