Specialty Navigator

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together.

Reporting to and working under the general direction of the Supervisor(s) and Manager of the department, the Specialty Navigator reviews complex referral requests and evaluates and assigns appropriate specialist for the patient. Works with patients and providers to understand services being requested. Interviews patients as needed to obtain full understanding of what information is being requested. Works closely with Specialty Nurses to ensure clinical handoffs are safe and appropriate. Coordinates care both within Reliant and Atrius Health and with external partners.

Schedule (40 hours/week): Monday - Friday 8:30am - 5pm EST or 8:00am - 4:30pm EST

If you reside within the state of Massachusetts, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Reviews referral information from clinicians for pertinent information regarding tests,consultations, and procedures
• Verifies demographics and insurance information
• Work is highly complex and detail oriented, involving frequent contact with a range of internal and external contacts as well as the need to understand terms and processes of multiple payers
• Reviews referral information from work queue for pertinent information regarding referralrequests
• Reviews each external referral for opportunity to convert to internal referral and reviews optionswith patients
• Redirects patients with managed care products appropriately ensuring clinicalhandoff is safe using expertise of specialty nurses
• Ensures adequate information is obtained and relayed when care is moved
• Explains insurance benefits and options to patients
• Explains denials to patients. Keeps patient informed of status of all referrals (approved and denied)
• Notifies patients of scheduled appointments and confirms appointment by mail including confirmed location and map of destination
• Informs patient of any preparation that must be completed prior to the appointment
• Contacts patient if insurance coverage issues arise during the referral process so that patient canwork directly with the insurance company
• Promotes the Reliant and Atrius Health System of Care by highlighting internal providers andtheir expertise
• As needed, places orders to start the referral process for the PCP on behalf of patients who havebooked appointments and call for the referral
• Researches the visit notes to determine if a referral was intended as well as processing referrals for follow-up or annual visits that require a referral
• Schedules patients for tests, consultations, services and procedures with other departments, localprivate offices, and/or outside vendors/providers
• Answers phone calls, faxed requests and other inquires relating to referrals and communicateswith the physicians and clinicians to acquire authorization or to inform them of patient issues orclinical paperwork needed
• Research questions/concerns from patients regarding bills and determines if issue is related to thereferral process
• Assists in resolving billing and denied referral matters as they relate to thereferral process
• Refers patients to appropriate staff (e.g., patient