Patient Navigator

AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area. With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our services for communities throughout New York. As we grow, our employees grow with us.

Summary of Position

• The Patient Navigator is responsible for making the patient experience smoother through coordination and processing of all patient referrals.
  
• Responsible for claims charge review edits related to the referrals, following protocols for proper authorization and processing of all referrals.

Principal Accountabilities

• Coordinates complex referral authorization requests and determines course of action based on plan guidelines. Consults with Patient Access Manager when appropriate.
  
• Follows ACP protocols and standing orders for proper authorization and processing of all referrals and completes all administration functions associated with referral activities in a timely manner. Recommends enhanced workflows for referral management.
  
• Responsible for monitoring all referral reports not received and timely follow-up in accordance with ACP policy and procedure. Recommends enhanced workflows to reduce referral errors and improve referral workflow.
  
• Monitors daily work queues and work lists generated from PSRs and call teams ensuring compliant referral processing and escalating any issues as appropriate to the manager. Recommends enhanced workflows to reduce referral errors and improve referral workflow.
  
• Acts as liaison between and advocate for patients. Addresses patient inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Explains policies and procedures to patients and refers them to the proper services required.
  
• Coordinates payor and group financial negotiations for out of network referrals following ACP, New York State, and payor guidelines for ensuring compliant referral processing.
  
• Performs other job-related duties as required.