Patient Navigator

• 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.

• 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.

• Must be a graduate from an accredited high school or GED program.
• Two years' experience preferably in a community health care setting.
• Bilingual in English and Spanish is preferred.
• Possess means of transportation.
• Valid Texas Driver's License and minimum liability insurance.

• Knowledge of corporate, Federal, State, and Joint Commission requirements/regulations.
• Basic knowledge of Bureau of Primary Health Care and Texas Department of State Health Services, expectations, rules and regulations.
• Ability to interpret, understand and carry out instructions and orders.
• Must be able to establish and maintain good working relationships with co-workers, visitors and patients.
• Must possess basic knowledge of compliance and HIPAA.
• Ability to accept supervision and direction.
• Ability to understand and communicate effectively both oral and written instructions.
• Ability to work effectively with others and to deal tactfully with professional personnel as well as with the public.
• Ability to work with individuals or in a group to promote community education client participation.
• Ability to express ideas clearly and problems or concerns, and also the ability to exercise good judgment in evaluating situations and in making recommendations.

Gateway Community Health Center