Patient Eligibility Specialist and Navigator

The Position

• The Patient Eligibility Specialist and Navigator plays a key role in supporting patients with bleeding disorders by guiding them through the financial aspects of their care. This role ensures that patients understand their insurance coverage, billing statements, and available financial assistance programs. The Patient Eligibility Specialist and Navigator collaborates with clinical staff, billing specialists, and external payers to resolve billing concerns and facilitate a seamless experience for patients and their families.

Key Responsibilities

• Serve as the primary point of contact for patients with billing and insurance-related questions and medication access issues

• Explain insurance benefits, coverage, co-pays, prior authorizations, and out-of-pocket costs to patients in a clear and compassionate manner.

• Maintain expert knowledge of and enroll patients in hemophilia-specific financial resources, including manufacturer co-pay programs, foundation grants, and patient assistance programs

• Support billing dept responsibilities including claims submissions, payment posting, and other AR activities including insurance follow-up

• Work closely with the billing team to monitor outstanding patient balances and proactively address potential billing issues.

• Update and help maintain patient insurance information within our pharmacy and billing software

• Educate patients on the financial aspects of their care and provide ongoing support throughout the treatment process.

• Help patients understand billing issues that may interfere with treatment, including prior authorizations, coverage, and eligibility.

• Coordinate with clinical and pharmacy staff to ensure accurate and timely insurance documentation. Track insurance denials and work with the billing department to support appeals or corrections.

• Work with clinical and billing teams to analyze denial trends, streamline workflows, and develop patient-facing educational materials on insurance literacy

• Maintain accurate, confidential records of patient interactions in compliance with HIPAA regulations. Participate in team meetings and collaborate with clinical and administrative staff to improve patient-centered financial services.

Qualifications

• High school diploma or equivalent required; associate or bachelor's degree in healthcare administration, social work, or related field preferred.

• At least 3 years of experience in a healthcare setting, preferably in billing, insurance coordination, or patient navigation.

• Knowledge of insurance processes, including Medicaid, Medicare, and commercial payers.

• Strong interpersonal, communication, and problem-solving skills.

• Ability to handle sensitive conversations with empathy and professionalism.

• Ability to translate complex insurance terminology into language accessible to patients and non-experts

• Experience with electronic health records (EHR) (NextGen) and billing software preferred.