Clinical Access Navigator

				Responsibilities:

Under the general supervision of Access Business Services management, the Clinical Access

Navigator serves as a liaison between Cooper providers and business operations, and insurance payors via the web and telephonically to provide clinical information necessary to secure prior authorizations for patient services.

Works both Patient and Referral Workqueues as needed.

Secures insurance authorizations and/or pre-certifications for patient services both internal and external to Cooper contacts and insurance payors in response to "peer-to-peer requests" and after denial to appeal payor's decision.

Gathers and submits necessary documentation required to successfully obtain prior authorization or pre-certification for patient services or to appeal denials.

Manages and documents patient and payor phone calls pertaining to medical conditions, prior authorizations and any questions according to established department routine.  Provides clear and accurate documentation in the system for all actions taken as well as outcomes.

Registers and Schedules patients as needed.

Works with ABS Authorization Specialists, ordering physician offices and staff, patients and patient families to resolve questions or issues concerning prior authorizations.  Responds appropriately within skill level and documented departmental policies and when appropriate.

Answers a high volume of inbound phone calls in a call center environment, as well as makes all necessary outbound phone calls to payors, providers and patients.  Follows through in a timely manner on payor and patient calls/requests. 

Handles all calls using ABS Telephone Scripting and QA Telephone Expectations.  Understands and utilizes features of the telephone and voice mail system (i.e. hold, transfer, forward, creation of changing of phone mail greetings, etc.)

Maintains ABS departmental quality and productivity standards.  Assists in the development, revision and maintenance of payor prior authorization/peer-to-peer/appeals protocols for staff and providers.

Efficiently operates computer, copier, fax machine, telephone system and performs numerous other clerical and technical duties in accordance with current procedures

Qualifications:

* Excellent verbal and written communication skills.
* Skilled in use of computers and software applications, i.e., Microsoft Word, Excel, Outlook. Analytical ability, good interpersonal staff skills, self-starter who needs little supervision
* Knowledge of electronic medical records.
* Ability to organize, take independent action and project Cooper Values to customers and co-workers.
			

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