Summary

The Department of Ophthalmology is looking for a Patient Navigator to join their PROSE service line.  This position coordinates appointments and facilitates communication between patients and the Ophthalmology providers. The Patient Navigator works collaboratively with physicians, advanced practice providers, nursing staff, and administrative teams to enhance the patient experience and support optimal clinical outcomes.

The ideal candidate will possess previous experience working with insurance carriers, benefits verification, and prior authorization requirements.

This position is located at our Jamal location.

Job Duties

• Schedules, coordinates and confirms appointments for the patient and facilitate communication among patients, providers, and multidisciplinary care teams.
• Provides information regarding insurance requirements
• Ensures patient eligibility and insurance benefits prior to scheduled appointments.
• Verifies insurance coverage through Availity, payer portals, or by contacting insurance companies directly.
• Obtains prior authorizations before ordering devices or contact lenses.
• Manages claim denials by reviewing, appealing, and resolving rejected or denied claims.
• Ensures all self-pay balances are collected before patients receive devices or contact lenses.
• Collects patient payments and process transactions accurately.
• Posts charges in Epic daily.
• Reviews guarantor accounts to verify the accuracy of charges and billing
• Tracks referrals, diagnostic results, and follow-up appointments to ensure continuity of care.
• Performs other duties as assigned

Minimum Qualifications

• High School diploma or GED.
• Four years of relevant experience.

Preferred Qualifications

• Experience in an Ophthalmology practice and or PROSE experience.