Patient Navigator/Data Entry Clerk

DESCRIPTION: To provide eligibility and enrollment assistance following the criteria set by the state programs which includes documentation, problem solving, determination of eligibility and accessibility to uninsured patients of the Center and community residents. Coordinates program services with providers, medical support staff, and community partners.

SUPERVISION: Directly supervised by Health Information Manager.

TYPICAL PHYSICAL DEMANDS: Requires prolonged sitting, stooping and bending. Occasional standing. Must be able to lift/carry up to 25 pounds. Requires the use of office equipment, such as computer, telephone, copiers and scanners.

ESSENTIAL FUNCTIONS:

• Provide application for eligibility and renewal assistance in state program by providing fair, impartial, and accurate information.
• Interviews clients to gather case management information, determines eligibility for medical or social services and appropriately refers to other agencies as needed.
• Provide information and assistance in the applicants preferred language and or provide limited-English proficiency applicants with oral and written notices of their rights to receive language assistance services and how to obtain such services.
• Evaluates information from interview to identify client’s need or problem.
• Maintains clients' records by reviewing case notes; logging events, progress, and posting of service coordination and navigation charges.
• Advises client or client’s relatives, if the case so merits, in formulating a service plan, explaining departmental functions and procedures. Describing feasibility and consequences of alternatives per provider recommendations.
• Ability to work in a variety of settings with culturally-diverse families and communities with the ability to be culturally sensitive and appropriate.
• Composes narrative reports, summarizing case activity and recommends further action as needed, as per provider recommendations.
• Assists patients in obtaining community assistance and/or referral.
• Ensures timely follow-up appointment with providers, of abnormal results and/or condition as per protocol or procedure.
• Ability to work independently with strong sense of focus, task-oriented, nonjudgmental, open personal qualities, clear sense of boundaries.
• Compiles, copy, and completes data for administrative reports, and other documents.
• Maintains and updates patient logs.
• Develops, maintains, and updates the department’s filing system.
• Participates in educational & promotional activities as requested.
• Participate in regular staff meetings, staff training programs, supervisory sessions, and accept the responsibility for aiding the development of positive team relationships as requested.
• Maintains customer confidence and protects operations by keeping information confidential, and adheres to HIPAA Regulations.
• Adhere to agency policy, procedures and the professional code of ethics.
• Maintains operations by following program policies & procedures.
• Contributes to team effort by accomplishing related results as needed.
• Performs other duties as assigned

SECONDAY FUNCTIONS:

• Enters customer and account data by inputting alphabetic and numeric information on keyboard or optical scanner according to screen format.
• Maintains data entry requirements by following data program techniques and procedures
• Receives, reviews, and prioritizes correspondence.
• Participates in educational and promotional activities as requested.
• Compiles, copy, and completes data for administrative reports, and other documents.
• Develops, maintains, and updates the department’s filing system.
• Keeps moderately complex records, to assemble and organize data, and prepares reports from such records.
• Reviews and electronically transmits claims, closes the day, compiles and prints daily reports.
• Maintains a log of all electronically and hardcopy (paper) filed claims.
• Responsible for downloading and printing Remittance and Status Reports or EOBs.
• Posts payments for all claims to patient’s account as per R&S or EOB.
• Runs receipts report to verify that all payments are posted by site and that the check amount reconciles with the computer total.
• Reviews, corrects and appeals rejected claims and answers any associated correspondence from the claim processing.
• Researches and resolves outstanding claims and payment issues for billing and resubmits claims accordingly or initiating the appeal process if needed.
• Investigates all denied claims by rejection code and acts accordingly to file appeals on rejected claims.
• Ability to view clinical data to fulfill responsibilities.
• Responsible to generate monthly reports for all payments received from services rendered by Center providers.