Job Posting: SUMMARY The Senior Patient/Provider Service Representative (Patient Navigator) has the responsibility of serving as the liaison between providers, patients, health plans and other internal departments, with a focus on senior patients. The position is the first point of contact for patients accessing Cedars Sinai Medical Group and Cedars Sinai Health Associates. In that capacity, the Sr. Patient/Provider Services Representative provides superior customer service, while welcoming the patient, educating them about the groups' programs and services and gathering and providing pertinent information to make their experience successful. DUTIES AND RESPONSIBILITIES
Monthly Outreach to newly enrolled Seniors; 1. Assist with PCP assignment 2. Assist in making 1st appointment 3. Conduct Meet & Greet tour at PCP office
Collaborate with the Senior Marketing Representative;
Work with operations managers to educate office staff on senior patient service expectations and resources including role of the Patient Navigator; conduct regular meetings with operations managers to educate/ update on senior-risk patients; identify barriers and propose solutions on an ongoing basis.
Conduct inventory to identify senior needs and improvement opportunities.
Serve as a liaison to all members of the care team and follow up with senior patients on care plan recommendations as needed; educate care team members about the patient navigator's role,
Promote organization's priorities around advance directive planning.
Collect and provide feedback to marketing (e.g., signage), operations (e.g., workflow), and business development on opportunities to improve services for seniors.
Share patient self-care issues with the Care Management department for social service interventions.
Run reports out of CRM and report to management the volume of calls, appointments and CSRs on a monthly basis (dash board).
Participate in outreach and community events pertaining to seniors.
Participate in Health Risk Assessment completion for each new enrollee and communicate with those support services that need to be brought into the patient care team.
Schedule and confirm appointments for seniors, as well as accommodations, e.g., transportation.
Serve as liaison to physician practices, billing and claims.
Participate in Community and Sr. Outreach projects, Health Fairs, etc.
Develop relationships with Senior Center administrators to increase knowledge of CSMG/CSHA.
Survey members based on Sr. disenrollment.
Assists patients who have managed care or fee for service insurance with their selection of a primary care physician by providing information about available physicians and following CSMG/CSHA policy regarding new patient assignment.
Verifies member eligibility via telephone, fax back or through the health plan web site and forwards information to enrollment for documenting in CS Link.
Completes a thorough and accurate registration on each patient, including demographic and insurance information; collaborates with the Enrollment Department or Physicians' Billing as needed.
Follows departmental procedures for following up with patients for whom complete information was not obtained at the time of contact to ensure an accurate patient record by the time of the appointment.
Determines patient's appointment needs and schedules new patient appointment per protocol;
Confirms patient appointments, as instructed;
Serves as liaison to physician practices and other CSMCF/CSMNS departments; assists patients through their interactions with these departments as necessary, to include follow-up with UM/Referrals Department on status of referrals as requested by provider/member and printing/faxing copies of approved referrals from AE when necessary.
Acts as the member/provider liaison with the Claims and Physician Billing Departments as needed to resolve any claims/billing issues.
Tracks/trends all member, provider and health plan inqui
Qualification Requirements/Preferences: Education Certifications/Licensure Experience Physical Abilities QUALIFICATIONS EDUCATION and/or EXPERIENCE High school diploma or general education degree (GED); 5 years' experience or equivalent education and experience in a medical practice, billing service, health plan or customer service department. Must have superior customer service skills and demonstrated knowledge of health insurance, managed care reimbursement and medical delivery system. Ability to tolerate high volume production and computer data entry standards. Ability to rapidly adjust thought process to multiple clients. Knowledge of IDX and PC skills preferred. AA degree, BI-lingual a plus. LANGUAGE SKILLS Strong written/verbal communication skills to include effective telephone dialogue skills. Ability to read and interpret documents, routine reports and correspondence, follow verbal instruction and understand and recognize medical terminology. MATHEMATICAL SKILLS Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. REASONING ABILITY Ability to apply common sense understanding to carry out detailed written or oral instruction. Ability to think critically, prioritize, problem solve and execute in a manner that promotes efficiency, accuracy and customer service. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scien...tists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.