Specialty Navigator II

** Requisition number:
** 2362398

** Job category:
** Medical & Clinical Operations

** HYBRID IN MASSACHUSETTS*
* Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start  
** Caring. Connecting. Growing together.*
* Reporting to and working under the general direction of the Supervisor(s) and Manager of the department, reviews complex referral requests and evaluates and assigns appropriate specialists for the patient. Works with patients and providers to understand services being requested. Interviews patients as needed to obtain full understanding of what information is being requested. Works closely with Specialty Nurses to ensure clinical handoffs are safe and appropriate.

Coordinates care both within Atrius Health and with external partners.

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* Schedule:

** Monday - Friday, 8:30am - 5pm

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* Location:

** This is a hybrid role, will be required to work onsite 1 day per week at 1177 BOSTON PROVIDENCE HWY NORWOOD, MA 02062

If you reside near  
** NORWOOD, MA** , you'll enjoy the flexibility of a hybrid-remote position
* as you take on some tough challenges.

** Department:
** Digestive Health

*
* Primary Responsibilities:

*
* + Reviews referral information from clinicians for pertinent information regarding tests, consultations, and procedures. Verifies demographics and insurance information. Work is highly complex detail oriented, involving frequent contact with a range of internal and external contacts as well as the need to understand terms and processes of multiple payers

+ Review referral information from work queue for pertinent information regarding referral requests

+ Reviews each external referral for opportunity to convert to internal referral and reviews options with patients. Redirects patients with managed care products appropriately ensuring clinical handoffs are safe using expertise of specialty nurses. Ensures adequate information is obtained and relayed when care is moved

+ Explain insurance benefits and options to patients. Explain denials to patients. Keeps patient informed of status of all referrals (approved and denied). Notified patients of scheduled appointments and confirms appointment by mail including confirmed location and map of destination. Inform patient of any preparation that must be completed prior to the appointment. Contacts patients if insurance coverage issues arise during the referral process so that patient can work directly with the insurance company

+ Promotes the Atrius Health System of Care by highlighting internal providers and their expertise

+ As needed, places orders to start the referral process for the PCP on behalf of patients who have booked appointments and call for the referral. Research the visit notes to determine if a referral was intended as well as processing referrals for follow-up or annual visits that require a referral

+ Schedules patients for tests, consultations, services and procedures with other departments, local private offices, and/or outside vendors/providers

+ Answers phone calls, faxed requests and other inquiries relating to referrals and communicates with the physicians and clinicians to acquiree authorization or to inform them of patient issues or clinical paperwork needed

+ Research questions/concerns from patients regarding bills and determines if issue is related to the referral process. Assists in resolving billing and denied referral matters as they relate to the referral process. Refers patients to appropriate staff (e.g., patient account representatives) for billing issues related to insurance benefits and services covered under the benefits plan

+ Works in collaboration with the person designated as the Practice's Benefits coordinator to maintain cost…