CLINICAL ACCESS NAVIGATOR
Company: Cooper University Health Care
Location: Camden
Posted on: July 7, 2025
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Job Description:
About us At Cooper University Health Care, our commitment to
providing extraordinary health care begins with our team. Our
extraordinary professionals are continuously discovering clinical
innovations and enhanced access to the most up-to-date facilities,
equipment, technologies and research protocols. We have a
commitment to our employees to provide competitive rates and
compensation programs. Cooper offers full and part-time employees a
comprehensive benefits program, including health, dental, vision,
life, disability, and retirement. We also provide attractive
working conditions and opportunities for career growth through
professional development. Discover why Cooper University Health
Care is the employer of choice in South Jersey. Short Description
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
Experience Required Minimum two years of general ambulatory office
experience. Clinical practice skills/skilled nursing experience
preferred, including but not limited to: writing orders,
interpreting labs/orders/patient assessments, working knowledge of
disease processes, and first-hand knowledge of caring for patients
within a demographic that radiology studies are indicated. Working
knowledge of medical insurance plans & products, coordination of
benefits guidelines, and requirements for authorizations and
pre-certifications preferred. Experience with securing prior
authorizations for services from third party payors preferred.
Proficiency in working with payor online portals, as well as
NaviNet, Passport or other third-party eligibility systems
preferred. Experience in resolving peer-to-peer review requests,
clinical reviews/authorizations and successfully appealing denials
from insurance payors preferred. Proficiency in Epic preferred.
Education Requirements Graduate of an accredited school of
practical nursing. License/Certification Requirements Current New
Jersey LPN License (Licensed Practical Nurse) BLS Certification
(Healthcare Provider Course) Special Requirements 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.
Keywords: Cooper University Health Care, Camden , CLINICAL ACCESS NAVIGATOR, Healthcare , Camden, New Jersey