LAI Financial Navigator JobDallas, TX
Why You'll Love This Job
Our Core Values:
At Prism Health North Texas, our actions are guided by our Core Values. These values shape every aspect of the employee experience, including hiring, development, performance, and accountability. They are evident in how we serve our patients, engage with communities, and support one another. Our Core Values are:
- We are solution seekers.
- We have a can-do attitude.
- We are mission driven.
- We care about people.
General Description:
The LAI Financial Navigator manages eligibility and insurance verification for patients receiving Long-Acting Injectable (LAI) therapy. The LAI Financial Navigator’s goal is to provide continuous documentation support by helping patients maintain eligibility requirements for service continuity. The LAI Financial Navigator works with patients to determine the payor source that should be used for the patient.
Responsibilities
Specific Responsibilities of the Job:
- Meets with patients receiving Long-Acting Injectable (LAI) therapy to coordinate authorization, prior authorization, and Patient Assistance Program enrollments.
- Communicates with patients about their financial responsibility for services.
- Ensures eligible funding is in place for patients receiving Long-Acting Injectable (LAI) therapy to be able to receive services.
- Responds to patients’ communication in a timely manner to prioritize eligibility maintenance.
- Documents LAI eligibility status and any related notes in the Electronic Health Record.
- Conducts funding verification, eligibility, and benefits each month and ensures all prior authorization is complete prior to delivery of patient services.
- Assists patients in understanding insurance benefits and patient financial responsibilities prior to services being rendered.
- Determines need for Authorizations and assists with coordinating referrals for services.
- Submits requests to insurance for Authorizations for patient services.
- Coordinates prescription benefits and prior authorizations prior to delivery of patient services.
- Manages patient’s health record to ensure that all required information is correct and complete in the Prism Health North Texas (PHNTX) system and information is available to provide services.
- Manages enrollment and required recertifications for Patient Assistance Programs and other medication access programs.
- Coordinates with Pharmaceutical companies to ensure processing of pending applications.
- Identifies ways to improve work processes or methods and makes recommendations to the Financial Navigator Director for appropriate changes.
- Other duties as assigned.
Skills & Qualifications
Required Knowledge, Skills and Abilities:
- Proficiency in Excel, Word, and Outlook.
- Demonstrated knowledge and experience working with a diverse client population.
- Demonstrated ability to handle multiple responsibilities to meet tight deadlines in a complex environment.
- Demonstrated knowledge of medical terminology and clinical processes.
- Ability to make decisions related to appropriate client care.
- Ability to effectively communicate in verbal and written formats.
- Ability to establish effective working relationships with clients.
- Ability to manage and work effectively in the required electronic medical record, database, or document portal.
- Ability to work in a multi-site work environment.
Education and Experience:
- A high school degree/diploma or GED.
- 5 years of experience in insurance verification and billing in a comprehensive and specialty care environment.
- Experience working with third-party billing service preferred.
- Certification in coding and billing preferred.
- Bilingual in English/Spanish is preferred.