Health Benefits Navigator

Essential Duties and Responsibilities

• Educate patients on insurance options, plan selection, and renewal processes.
• Response to patient requests about insurance applications, coverage, benefits and any other patient insurance concerns, either by phone, electronically (electronic health records) or in person.
• Resolve eligibility issues and support retention of coverage.
• Aid with insurance applications via state systems or paper forms.
• Conduct follow-up to ensure enrollment completion and support retention of coverage.
• Verify insurance coverage, effective dates, PCP assignment for ACO patients, co-pays, and benefits in electronic health records (EHR) and make updates as needed.
• Provide information about financial assistance program options, including sliding fee scale.
• Inform patients of co-pays, balances, and payment responsibilities.
• Collect payments (cash, check, credit card, online) and issue receipts.
• Assist patients with MyChart enrollment for online payments and communication.
• Schedule, reschedule, or cancel appointments as needed.
• Ensure accurate data entry in the EHR system.
• Represent the organization at community events and health fairs, providing culturally appropriate education.
• Document outreach activities and participant engagement.
• Support patient accounts team with ad hoc billing issues.
• Deliver exceptional customer service and resolve patient concerns promptly.
• Communicate with care teams to ensure smooth patient flow.
• Collaborate with front desk, call center, and billing teams to reduce handoffs.
• Participate in trainings and maintain Navigator Certification (initial and annual renewal).

Qualifications

• A high school diploma or equivalent.
• Additional education in healthcare or administration preferred.
• 2+ years of customer service experience, preferably in healthcare.
• Strong communication, organizational, and computer skills (Microsoft Office, EHR systems).
• Ability to work independently and as part of a team.
• Bilingual language proficiency is highly valued, Spanish and Portuguese preferred.
• Knowledge of insurance programs, eligibility processes, and prior authorization preferred.
• Ability to maintain patient confidentiality and comply with HIPAA regulations.