At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development.
Discover why Cooper University Health Care is the employer of choice in South Jersey.
Short Description:
Under the general supervision of Access Business Services management, the Clinical Access
Navigator serves as a liaison between Cooper providers and business operations, and insurance payors via the web and telephonically to provide clinical information necessary to secure prior authorizations for patient services.
Works both Patient and Referral Workqueues as needed.
Secures insurance authorizations and/or pre-certifications for patient services both internal and external to Cooper contacts and insurance payors in response to “peer-to-peer requests” and after denial to appeal payor’s decision.
Gathers and submits necessary documentation required to successfully obtain prior authorization or pre-certification for patient services or to appeal denials.
Manages and documents patient and payor phone calls pertaining to medical conditions, prior authorizations and any questions according to established department routine. Provides clear and accurate documentation in the system for all actions taken as well as outcomes.
Registers and Schedules patients as needed.
Works with ABS Authorization Specialists, ordering physician offices and staff, patients and patient families to resolve questions or issues concerning prior authorizations. Responds appropriately within skill level and documented departmental policies and when appropriate.
Answers a high volume of inbound phone calls in a call center environment, as well as makes all necessary outbound phone calls to payors, providers and patients. Follows through in a timely manner on payor and patient calls/requests.
Handles all calls using ABS Telephone Scripting and QA Telephone Expectations. Understands and utilizes features of the telephone and voice mail system (i.e. hold, transfer, forward, creation of changing of phone mail greetings, etc.)
Maintains ABS departmental quality and productivity standards. Assists in the development, revision and maintenance of payor prior authorization/peer-to-peer/appeals protocols for staff and providers.
Efficiently operates computer, copier, fax machine, telephone system and performs numerous other clerical and technical duties in accordance with current procedures
Experience Required:
Minimum two years of general ambulatory office experience.
Clinical practice skills/skilled nursing experience preferred, including but not limited to: writing orders, interpreting labs/orders/patient assessments, working knowledge of disease processes, and first-hand knowledge of caring for patients within a demographic that radiology studies are indicated.
Working knowledge of medical insurance plans & products, coordination of benefits guidelines, and requirements for authorizations and pre-certifications preferred.
Experience with securing prior authorizations for services from third party payors preferred.
Proficiency in working with payor online portals, as well as NaviNet, Passport or other third-party eligibility systems preferred.
Experience in resolving peer-to-peer review requests, clinical reviews/authorizations and successfully appealing denials from insurance payors preferred.
Proficiency in Epic preferred.
Education Requirements:
Graduate of an accredited school of practical nursing.
License/Certification Requirements:
Current New Jersey LPN License (Licensed Practical Nurse)
BLS Certification (Healthcare Provider Course)
Special Requirements:
Excellent verbal and written communication skills.
Skilled in use of computers and software applications, i.e., Microsoft Word, Excel, Outlook. Analytical ability, good interpersonal staff skills, self-starter who needs little supervision
Knowledge of electronic medical records.
Ability to organize, take independent action and project Cooper Values to customers and co-workers.
Salary Min ($): USD $21.00 Salary Max ($): USD $34.00
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