About Us
At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer‑centric company dedicated to making a positive impact on people's lives.
Position Summary
The Patient Navigator is responsible for providing exceptional customer services that include case coordination to patients and healthcare practitioners (HCPs) and their staff. This person will be a member of a large team, dedicated to supporting a high‑volume call environment within a team environment. The Patient Navigator will provide education to patients or caregivers on the enrollment process, status inquiries and confirm scheduled deliveries of prescribed therapies from specialty pharmacies. To support the patient journey, the Patient Navigator will be interacting with Pharmacy Benefit Managers (PBMs), Payers (Insurers), customers (patients), and healthcare providers to gather patient information and confirm reimbursement coverage.
Key Responsibilities
* Provide subject‑matter expertise of program requirements and reimbursement status while maintaining a high level of customer service, sense of urgency, reliability, error‑free data entry skills, active listening, proper phone etiquette, verbal and writing skills, and teamwork spirit.
* Act as the single point of contact and voice for patients, functioning as a patient advocate with compassion.
* Perform reimbursement‑related activities such as benefit investigations for providers and/or patients.
* Provide exceptional customer service to internal and external customers; resolve requests timely and accurately; and elevate complaints according to defined SOPs.
* Maintain frequent phone contact with patients, third‑party customer‑service representatives, and pharmacy staff.
* Validate completeness of all required information within case notes, notify urgent orders, shipping issues, errors, complaints, or adverse drug events to the appropriate third party or system.
* Report all adverse events disclosed in alignment with training and SOPs.
* Demonstrate extensive knowledge of HIPAA regulations and follow all company policies.
* Meet performance standards aligned with predefined metrics or KPIs.
* Adapt flexibly to changing duties or new assignments on short notice.
Qualifications
* High School Diploma or GED required; Associate or College Degree preferred.
* Experience working in a high‑volume call center required.
* Previous experience in a pharmacy, healthcare office, or health insurance provider highly desirable.
* Thorough understanding or working knowledge of commercial and major medical insurance programs, billing requirements, healthcare benefit investigation processes, prior authorization, and appeal filings.
Skills
* Knowledge of private payers, pharmacy benefits, medical benefits, Medicare Part D, Medicaid, and alternate funding resources.
* Demonstrated organization and problem‑solving skills for patient conversations, issue identification, and needs assessment.
* Comfortable multitasking across multiple applications while capturing case information.
* Proficient with Microsoft Office (Excel, Word, Outlook, SharePoint) and Lotus Notes Suite.
* Professional communication skills, courteous attitude toward customers and colleagues.
* Strong analytical, critical thinking, and independent working skills.
* Ability to work independently or as part of a team.
* Effective verbal and written communication with high customer service standards.
* Ability to remain composed in stressful environments.
Work Environment
* Location: Remote
* Schedule: Full‑time Monday‑Friday; occasional weekends may be required.
* Additional availability or flexibility for escalations may be needed.
* Regular meetings with team, department, or leadership for alignment.
Key Essential Functions
* Ability to sit for extended periods while working at a computer and on the phone.
* Ability to engage in continuous phone and computer use, navigating multiple systems simultaneously.
* Ability to perform repetitive motions for an entire shift, including typing, mouse use, and phone handling.
* Ability to view and read information on a computer screen for prolonged periods.
* Ability to communicate clearly and professionally via phone, email, and internal systems.
* Ability to manage a high volume of inbound and outbound calls while maintaining attention to detail and accuracy.
* Ability to work remotely with minimal distractions and maintain productivity and performance standards.
* Ability to adapt to changing priorities, workflows, and processes in a fast‑paced environment.
* Ability to meet attendance, schedule adherence, and performance expectations, including flexibility for occasional extended hours or weekends as business needs require.
Employment Classification
Status: Full‑time
FLSA: Non‑Exempt
Seniority Level
Entry level
Employment Type
Full‑time
Job Function
Other, Information Technology, and Management
Industries
Technology, Information and Internet
Equal Employment Opportunity Statement
Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status.
We celebrate diversity and are committed to creating an inclusive environment for all employees. If you do not meet every requirement but still feel you would be a great fit for this role, we encourage you to apply!
Disclaimer
This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel. Gifthealth reserves the right to modify job duties or descriptions at any time.
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