Job Description

The RMG Sleep Medicine Patient Navigator reflects the mission vision and values of NM adheres to the organizations Code of Ethics and Corporate Compliance Program and complies with all relevant policies procedures guidelines and all other regulatory and accreditation standards.

This position will have comprehensive knowledge of Sleep Medicine patient needs and will work in partnership with the physicians and clinical staff to ensure a smooth and efficient process. This position performs registration scheduling insurance verification/precertification and clerical functions in an accurate timely manner and they will work closely with DME vendor delivering the highest level of customer service over the phone and in person.

Responsibilities:

• Acts as new patient navigator to set up appointments obtain referrals related medical records. Performs benefit investigation
• Responds to all incoming calls for Sleep patients and schedules all appointments billing and insurance inquiries
• Schedules DME setups coordinates between patient department and DME or required DME vendordepending on patient zipcode.
• Works with FCC on authorizations for home sleep teststracks orders and authorizations while maintaining communication with patients during this process.
• Processing orders for CPAP machine and suppliesthis entails filling out required paperwork forms and sending required medical records to DME vendor in order for insurance to cover. All plans have different rules and requirements and the navigator must be well versed in all the insurance coverage policies. Must also know what DME equipment is covered by each insurance company.
• Works with Sleep Educator to schedule patient once DME equipment is approved and received.
• Coordinates provider appointments after equipment is received. Per Medicare guidelines patients must be seen between 31 and 90 days of receiving equipment.  If patients are not seen in this timeframe they are deemed noncompliant and the entire process must be repeated.
• Acts as Customer Service Representative for sleep patients. Addresses all patient concerns related to equipment coverage or benefits and relays information to physicians clinical staff or DME company as indicated.
• Schedules peer to peers insurance reviews and submits all paperwork for insurance/coverage appeals for insurance denials.
• Investigates and tracks charts for sleep studies and machines in order to receive payment through DME company.
• Schedules Telemed appointments.
• Performs other duties as assigned by Manager of Durable Medical Equipment.

Qualifications :

Required :

• High School diploma or GED equivalent.

• Minimum of 3 years of medical office experience.
• Experience with electronic medical record.

Preferred :

• Procedural and insurance authorization experience.

Additional Information :

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age sex race color religion national origin gender identity veteran status disability sexual orientation or any other protected status.

Remote Work :

No

Employment Type :

Fulltime

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