Financial Navigator

Job Description

General Description:

The Financial Navigator manages eligibility and insurance verification for patients. The Financial Navigator’s goal is to provide continuous documentation support by helping patients maintain eligibility requirements for service continuity. The Financial Navigator is to work with patients to determine the payor source that should be used for the patient.

Responsibilities Specific Responsibilities of the Job:

Meets with patients to complete eligibility documentation.

Maintain eligibility documentation for new and existing outpatient medical care patients.

Responds to patients’ communication in a timely manner to prioritize eligibility maintenance.

Document eligibility status and any related notes in the EHR.Upload eligibility documentation and agency documents into document portal and EHR.Conduct insurance verification, eligibility, and benefits before each medical visit and ensure all prior authorization is complete prior to delivery of ambulatory practice services.

Assists patients in understanding insurance benefits and patient financial responsibilities prior to services being rendered.

Manage patient’s health record to ensure that all required information is correct and complete in the Prism Health North Texas (PHNTX) system and information is available to provide services.

Refer patients identified with multiple needs to clinic case managers for assessment.

Other duties as assigned.

Direct Reports:
None.

Skills & Qualifications Required Knowledge, Skills, and Abilities:

Job Requirements:

Proficiency in Excel, Word, and Outlook.

Demonstrated knowledge and experience working with clients with mental health and substance use disorders.

Demonstrated ability to handle multiple responsibilities to meet tight deadlines in a complex environment.

Demonstrated knowledge of physician reimbursement, medical terminology, ICD-10, CPT and HCPCS coding

Ability to make decisions related to appropriate client care.

Ability to effectively communicate in verbal and written formats.

Ability to establish effective working relationships with clients.

Ability to manage and work effectively in the required electronic medical record, database, or document portal.

Ability to work in a multi-site work environment.

Education and Experience:

A high school degree/diploma or GED.
5 years of experience in insurance verification and billing in a comprehensive and specialty care environment. Experience working with third-party billing service preferred.

Certification in coding and billing preferred.

Bilingual in English/Spanish is preferred.
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