Referral Navigator at Novant Health

Job Title: Referral Navigator

Location: Novant Health’s SC Physician Practices

General Summary: The Referral Navigator is responsible for managing and facilitating a referral process from external entities, coming into Novant Health physician practices. The Referral Navigator will offer a seamless referral process to ensure patients receive timely care and accurate information while maintaining a high level of customer service. The role will expand as Novant Health grows in South Carolina.

Essential Job Responsibilities:

1. Adhere to and support the mission, purpose, philosophy, objectives, policies, and procedures of Novant Health.

2. Ensure compliance with HIPAA regulations and maintain confidentiality in accordance with privacy standards.

3. Demonstrate support for corporate compliance by being knowledgeable of compliance responsibilities and adhering to federal and state laws, regulations, and corporate policies that affect job functions. Report compliance issues in a timely manner.

4. Manage incoming patient referrals from external entities.

5. Register referred patients into practice management/electronic medical record system and obtain any outstanding information required to schedule their appointments.

6. Contact patients to gather necessary details, clarify referral requirements, and schedule appointments with the appropriate provider.

7. Coordinate and follow up on appointments to ensure patients are seen by the correct provider in a timely manner.

8. Provide patients with accurate, clear information about their referral, appointment scheduling, and any necessary documentation.

9. Serve as the primary point of contact between external referrers, patients, and Novant Health physician practices, ensuring seamless communication and a high-quality referral experience.

10. Act as a liaison between referring entities and Novant Health physician practices to ensure smooth and accurate information exchange.

11. Track and maintain records of all referrals, ensuring patient charts are updated and referral data is captured accurately in the system.

12. Follow up with referring entities regarding appointment confirmations.

13. Address any issues or concerns from referring providers or patients and resolve them promptly.

14. Assist patients with insurance-related questions and verify insurance information when necessary to ensure appointments are scheduled appropriately.

15. Work with insurance companies as needed to confirm pre-authorizations and secure approvals for services.

16. Maintain knowledge of Novant Health’s referral processes and work to continuously improve the overall efficiency and quality of the referral process.

17. Perform other related duties and responsibilities as assigned.

Education:

· High School Diploma/GED required.

Experience:

· Minimum of 4 years of experience working in a medical office setting, with a focus on managing patient referrals, scheduling, and coordinating care.

· Experience using Electronic Health Systems, specifically Athena, preferred.

Other Requirements:

· Excellent organizational and time-management skills.

· Strong attention to detail and ability to follow processes accurately.

· Ability to maintain a high level of customer service while managing multiple tasks.

· Exceptional communication skills, both written and verbal, for clear and professional interactions with patients, external entities, and internal teams.

· Ability to handle sensitive and confidential patient information with discretion.

Performance Requirements:

Knowledge:

1. Knowledge of the referral process and insurance verification, including pre-authorization and authorization processes.

2. Familiarity with insurance policies, such as Medicare, Tricare Prime, and other payer-specific guidelines.

3. Proficiency in Electronic Health Systems (Athena preferred) and documentation requirements for physician appointments.

4. Knowledge of ICD-9, ICD-10, and CPT codes.

5. Awareness of clinic policies and procedures to provide effective patient care.

Skills:

1. Strong multi-tasking abilities with the capability to manage multiple referrals simultaneously.

2. Excellent customer service skills, with the ability to manage patient expectations and provide a positive referral experience.

3. Ability to troubleshoot issues and resolve challenges with minimal supervision.

4. Ability to communicate clearly and empathetically with patients and external partners.