Insurance Navigator en RiverStone Health

Working title: Insurance Navigator 

Classification title: Administrative Services Coordinator 1

 Division: Community Health Center

 Program: Care Management

Reports to: Care Management Services Manager 

FLSA status: Non-Exempt: Full-Time

Schedule: Monday-Friday; 8am-5pm

Wage Range: $19.21 to $23.48 hourly; depending on number of years of transferrable experience and internal equity

Overview: 

Serving the Yellowstone County community and south-central Montana for nearly 50 years, RiverStone Health is an essential provider of personal and public health services. Health, Education, Leadership and Protection – HELP is what we do.  From medical, dental and behavioral healthcare; home care and hospice; public health services like immunizations, WIC, health promotion and restaurant inspections; and educating the next generation of health professionals, our expertise spans all ages and stages of life.  Underlying principles of access, affordability, compassion and quality in all interactions, RiverStone Health improves life, health and safety for all of the communities we serve.

Job Summary:

Works with patients and community members to provide education and assistance related to insurance options and enrollment in Medicaid, Healthy Montana Kids, Health Insurance Marketplace and Medicare.

Essential Functions/Major Duties and Responsibilities:

A.     Insurance Navigation                                                                           70%

• Educate and assist individuals to enroll in Medicaid, Healthy Montana Kids (HMK), Health Insurance Marketplace, and Medicare.

• Maintain knowledge of eligibility requirements for Medicaid, HMK, Health Insurance Marketplace, and Medicare.

• Maintain accurate documentation in the electronic medical record (ECW) for insurance assistance and enrollment encounters.

• Provide insurance enrollment assistance to ensure accurate and timely submission of required documentation.

• Maintain a caseload of individuals that have applied for health insurance to facilitate completion of application and submission of required documentation.

• Monitor for active health insurance coverage and enter into the electronic medical record (ECW) in a timely manner.

• Schedule and monitor daily insurance appointments to ensure individuals are seen in a timely manner.

• Monthly outreach at RSH Satellite Clinic locations to provide insurance enrollment in underserved populations (Worden, Bridger, Joliet, WOW bus) and other locations as identified by the supervisor.

B.     Patient Outreach                                                                                   25%                                                     

• Outreach to patients presenting to RiverStone Health Clinic who are listed as self-pay or without insurance, to inform them about available health insurance options.

• Assist patients with eligibility requirements and enrollment in the sliding fee scale discount program.

• Keep immediate supervisor and designated others accurately informed regarding work progress, including present and potential issues, as well as suggestions for new or improved ways of addressing such concerns.

• Attend meetings, conferences, workshops, and training sessions to remain current on principles, practices, and new developments relevant to assigned work areas.

• Return calls and respond to patients’ questions and comments in a courteous and timely manner.

• Ensure that patients have access to primary medical and dental services by assisting them to understand the role of a primary care provider, select a provider, and make appointments or other necessary connections.

• Educate staff on the importance of a team approach to patient care, emphasizing the collaborative effort between clinical and nonclinical staff (including physicians, nurse practitioners, physician assistants, nurses, medical assistants, educators, front desk staff, schedulers, etc.) to achieve stated objectives.

Non-Essential Functions/Other duties as assigned                                ≥5%

• Perform other duties as assigned in support of RiverStone Health’s mission and goals.

Education and Experience: 

Minimum Qualifications

• High School diploma or equivalent

• Experience working in customer service environment, in person and on the phone

• Any combination of experience and training which provide the equivalent scope of knowledge, skills, and abilities necessary to perform the work.

Preferred Qualifications:

• Insurance enrollment experience

• Experience working with underserved population

Certificates, Licenses, Registrations:

• Current Montana Driver’s License is in good standing.

• Successful completion of annual Certified Application Counselor for Health Insurance Marketplace (can obtain after hire)

• Successful completion of annual Medicare SHIP Counselor Training (can obtain after hire)

Knowledge, Skills, and Abilities:

• Computer literacy, in Microsoft Office Suite.
• Knowledge of modern office procedures, practices and equipment.
• Ability to maintain a calm and positive demeanor during difficult client interactions.
• Ability to display non-judgmental and empathetic listening skills.
• High degree of detail-oriented skill level.
• Knowledge and understanding of protected sensitive patient health information (HIPAA) and confidentiality.
• Ability to work collaboratively and maintain a positive work environment.
• Ability to communicate clearly and effectively with supervisors, co-workers and customers.
• Ability to prioritize and perform a wide range of tasks under pressure of continuous interruptions.
• Ability to perform job duties with integrity and innovation to ensure completion and a high level of quality.
• Ability to understand and adhere to required administrative policies and procedures.

Customer Service Excellence: 

• Provides Customer Service Excellence to RiverStone Health’s customers, including patients, clients, family members, visitors, medical staff, and co-workers. 
• Doing things right the first time.
• Making people feel welcome.
• Showing respect for each customer.
• Anticipating customer needs and concerns.
• Keeping customers informed.
• Helping and going the extra mile.
• Responding quickly.
• Protecting privacy and confidentiality.
• Demonstrating proper telephone etiquette.
• Taking responsibility for handling complaints.
• Being professional.
• Taking ownership of your attitude toward Service Excellence.

Supervision: 

• None

Physical Demands and Working Conditions: 

• Work is mainly performed on a computer up to 8 hours per day.

• Create and maintain a safe/secure working environment by adhering to safety, security, and health requirements. Integrates injury, illness, and loss prevention into job activities by attending any necessary training and implementing best practices.

• Required to travel to different clinic locations 1-2 times per month

• Frequent standing, bending, sitting, lifting required

• Frequent customer interaction via telephone

Freedom to Act & Decision Making: 

• Ability to manage multiple tasks throughout the day and ensure tasks are completed in a timely manner.

• Ability and willingness to quickly learn and put to use new skills and knowledge brought about by rapidly changing information and/or technology.

• Ability to organize day to day responsibilities independently with assistance from the Care Management Services Manager as needed.

Communications & Networking: 

• Daily written and verbal communication with patients and their families, co-workers and community partners.

• Maintain HIPPA compliant records and communication.

Budget & Resource Management: 

None