Patient Navigator 2

JOB SUMMARY

Provide a description of the overall purpose of the position. “Why does this position exist?”

State the general nature, level and purpose of the job and a brief description of the duties and responsibilities. It may be easier to write the general summary after completing other sections of the job description.

Reports to the  Business Manager, and is guided by the procedures of Inpatient and Outpatient services, the Registration is responsible for providing support to all intensive (Inpatient, Partial Hospitalization, Intensive Outpatient Program, consult Liaison and Electroconvulsive Therapy) patients seeking services at Langley Porter Psychiatric Hospital- UCSF Health. The Registration  is responsible for reception, registration, insurance coverage verification, relaying financial information, providing financial need applications, and patient processing. Along with supporting the Utilization Review Coordinator with analyzing patient records to determine legitimacy of admission, length of stay, and compliance with insurance reimbursement. Receives assignments in the form of objectives with goals and the processes by which to attain them. Serves as a clinical resource and liaison for patients and their families and assists with navigating all aspects of the healthcare system. 

DUTIES & ESSENTIAL JOB FUNCTIONS

%  

of time

Essential Function (Yes/No)

Key Responsibilities

(To be completed by Supervisor)

Patient Navigation and Processing 

• Communicates LPPHC administrative and financial policies clearly to patients, answering patient account questions and knowing when to refer patients to financial counseling, billing partners, patient relations or other support departments for additional help.

• Understands how to identify and interpret a patient’s insurance benefit package, including pharmacy and mental health carve outs.

• Address patient complaints from patients regarding billing and complaints related to billing that come out of Patient Relations.

• Understands the concept of managed care and is knowledgeable about the resources available to the staff in regard to knowing the specific requirements of individual managed care plans. Assist patients to understand the concept of managed care.

• Managed front desk inquiries—both face-to-face and via telephone—while accurately addressing patient questions regarding insurance benefits and coverage. 

• Obtains and documents insurance authorizations for established patient visits, referrals and procedures or ancillary services. Communicates clinical information from medical records authorization requests to insurance companies.

• Works work queues to secure estimate letters and information for accurate billing submissions or to respond to denials such as retro authorizations, clinical documentation, and addended authorizations with add on CPT codes.

• Secures prior authorization for procedures, specialty visits and ancillary testing and coordinates with Hospital Admissions Department as needed.

• Collects and verifies insurance and referral/authorization information for appointments ensuring referral records and Hospital Accounts Records (HARS) are created and assigned to the appointment.

• Secures complex insurance authorizations for services, and is able to track the authorizations for renewal based on insurance company driven limits of time frames or numbers of visits or services.

• Other Duties as assigned.

10

Patient Information inptatient Coordination 

• Manages patient expectations by providing Mental Health -specific insurance QOB guidelines related to service/visit. 

• Obtains appropriate consents, PAFRs and signed documents at first visit 

• Creates a professional and positive first impression for patients and referring physicians. Demonstrates good judegement and common sense. 

• Maintaines and adheres to patient confidenitality and HIPAA guideliens including the distribution of NOPP (Notice of Privacy Practices) and PAFR (Patient Financial Responsibility form) 

10

General Patient Navigator Tasks

 • Liaises between patients and the services they receive 

• Coordinates care for patients amongst the various services of Langley Porter Hospital and UCSF Health

• Interacts via telephone and face to face with a wide range of adult clinical populations

• Triages urgent matters to appropriate resources in collaboration with patient, family members, primary care providers, mental health providers, insurance companies, and medical groups

• Follows up as needed with patients and stake holders

• Provides excellent customer service skills with patients and staff

• Prioritizes multiple tasks

• Maintains good working relationships with staff, patients, and providers

Utilization Review Tasks 

• Communicates with third party payers in order to obtain authorization for care and facilitates clinical denial and appeal process as necessary. 

• Makes timely documentation of all communications with payers and clinicians by keeping patient-care teams informed of changes and updates in processes, technology, regulations and quality standards. 

• Reports issues to appropriate provider and/ or department manager and solicits feedback on patient/family interactions/style efficacy from peers and managers. 

• Coordinates clinical and non-clinical resources based upon patients’ diagnosis, insurance coverage and community programs. Demonstrates knowledge of patients based on review of medical records to explain treatment options. Identifies patients’ preferences, and any barriers to the treatment plan implementation. 

5

• Services as a back up to inpatient registration coordinator. Other duties as assigned.  

100%

(To update total %, enter the amount of time in whole numbers (without the % symbol - e.g., 15, 20) then highlight the total sum (e.g., 1%) at the bottom of the column and press F9. The total sum should add up to 100%.)

LIVING PRIDE STANDARDS

Service Excellence

• Demonstrates service excellence by following the Everyday PRIDE Guide with the UCSF Medical Center standards and expectations for communication and behavior.  These standards and expectations convey specific behavior associated with the Medical Center’s values: Professionalism, Respect, Integrity, Diversity and Excellence, and provide guidance on how we communicate with patients, visitors, faculty, staff, and students, virtually everyone, every day and with every encounter. These standards include, but are not limited to: personal appearance, acknowledging and greeting all patients and families, introductions using AIDET, managing up, service recovery, managing delays and expectations, phone standards, electronic communication, team work, cultural sensitivity and competency.   

• Uses effective communication skills with patients and staff; demonstrates proper telephone techniques and etiquette; acts as an escort to any patient or family member needing directions; shows sensitivity to differences of culture; demonstrates a positive and supportive manner in which patients / families/ colleagues perceive interactions as positive and supportive. Exhibits team work skills to positively acknowledge and recognize other colleagues, and uses personal experiences to model and teach Living PRIDE standards. 

• Exhibits tact and professionalism in difficult situations according to PRIDE Values and Practices

• Demonstrates an understanding of and adheres to privacy, confidentiality, and security policies and procedures related to Protected Health Information (PHI) or other sensitive and personal information.

• Demonstrates an understanding of and adheres to safety and infection control policies and procedures.

• Assumes accountability for improving quality metrics associated with department/unit and meeting organizational/departmental targets. 

Work Environment

• Keeps working areas neat, orderly and clutter-free, including the hallways.  Adheres to cleaning processes and puts things back where they belong. Removes and reports broken equipment and furniture.

• Picks up and disposes of any litter found throughout entire facility. 

• Posts flyers and posters in designated areas only; does not post on walls, doors or windows.

• Knows where the Environment of Care Manual is kept in department; corrects or reports unsafe conditions to the appropriate departments. 

• Protects the physical environment and equipment from damage and theft.

OTHER FUNCTIONS AND RESPONSIBILITIES

Duties listed in this section are not essential or intrinsic to the job but are performed at times.

 Included in this section should be a general statement such as. “Perform other duties as assigned.” 

This phrase allows the supervisor to assign sporadic or one-time tasks as needed.

Please list:

• Performs other duties as assigned.

• Covers Front Desk duties as needed

REQUIRED QUALIFICATIONS

• This position requires flexibility to orient and work at all UCSF Medical Center locations.

• One year related experience.

• Bachelor's degree in related area and / or equivalent experience / training. 

POPULATIONS SERVED

Employees who routinely provide direct patient care require a statement concerning Populations Served Competencies. Typically, a statement such as “Demonstrated ability to provide appropriate care based on the needs of a specific individual, including the patient’s age.” is sufficient. Select from the following patient age categories.

Adolescent     

Adult              

Geriatric