Health System Navigator

This position supports our Health Share partners, Oregon Health Authority staff, and Care Coordination teams with complex system navigation relating to Oregon Health Plan benefits and eligibility and provider and health plan assignment issues through problem solving and advocacy for members. This position develops strong working relationships and regular collaborative communication with internal teams and plan partner teams to resolve individual member issues, as well as address systemic barriers as they occur within the Health Share structure. This position is responsible for data entry, data tracking, and customer service functions to assist members in accessing their Health Share Medicaid benefits. This position also assures members have smooth transitions between Health Share and health plan partners as needed and provides culturally responsive information and education about members’ benefits, rights, and responsibilities. This position requires critical thinking, strong communication skills, a desire to collaborate, and independent judgment.

This is hybrid position with the expectation to be in the office 1x per week. Candidates must reside in Portland Metro.

Estimated Hiring Range

$25.83 - $31.57

Essential Responsibilities

• Work collaboratively with providers, partners, Oregon Health Authority, plans and members to ensure member needs are addressed through routing and tracking of communication to the assigned plan partner, including customer service.
• Utilize various platforms to respond and/or route member inquiries, research member plan assignment and eligibility.
• Utilize spreadsheets and other systems to track member data received from OHA, plan partners, etc.
• Manage contact lists for plan partners to ensure cases and member concerns are routed to correct contacts.
• Advocate for member’s rights and needs to providers, OHP, plans and partners.
• Connect to plan partner teams to address cases received from OHA.
• Assure members are carefully transitioned to the correct partners when applicable.
• Maintain relationships with partners and providers to facilitate positive communication and shared problem solving.
• Provide proactive value-added service by identifying and reporting system issues within the Health Share structure.
• Collaborate with Community Engagement and Communications staff on development of member collateral.
• Serve as liaison to and maintain current knowledge of Health Share’s delegated member services function.
• Attend regional meetings to provide updates to Community Partners.
• Assist Clinical Operations Manager with projects intended to foster integration across Health Share partners
• Answer questions from the community about member benefits, rights, and responsibilities.
• Add updates to member profiles in proprietary software systems.
• Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol.
  
  

Knowledge

Knowledge, Skills and Abilities Required

• Knowledge of the basic concepts of Managed Care
• Knowledge of medical terminology
  
  

Core Skills And Abilities

• Ability to learn and apply Oregon Administrative Rules (OARs), Federal laws and other regulatory agencies that relate to the medical health insurance industry and the Medicaid or Medicare industry
• Ability to learn basic knowledge of CMS and UB-92 claim forms
• Excellent interpersonal, written, and oral communication skills
• Strong active listening skills and the ability to ask probing questions, understand concerns
• Excellent customer service skills, including the ability to interact professionally, patiently, and courteously
• Ability to articulate complex information in an easy-to-understand manner
• Ability to interpret and appropriately apply policy provisions
• Ability to use various portals to access data, utilize Excel to track data
• Effective conflict resolution skills
• Strong research, analytical and sound problem-solving skills
• Ability to work within a framework of written and unwritten highly diverse standards, policies, and practices to fulfill high level quality services to members
• Ability to work effectively with a team, and exercise sound judgment in handling assigned tasks
• Maintenance of strict confidentiality
• Ability to multitask and manage multiple priorities in a fast-paced environment
• Ability to work with many cross-functional areas and levels of staff, including diverse individuals
  
  

Physical Skills And Abilities

• Ability to perform repetitive finger, wrist, shoulder, or neck movement for at least 6 hours/day
• Ability to see, read, hear, and speak clearly for at least 6 hours/day
  
  

Cognitive Skills And Abilities

• Ability to focus on and comprehend information and learn new skills and abilities
• Ability to assess a situation and seek or determine appropriate resolution
• Ability to accept direction and feedback, as well as tolerate and manage stress
  
  

Required

Education and/or Experience

• Minimum 2 years’ experience in customer service in a health care setting
  
  

Preferred

• Experience providing customer service in a managed care setting
  
  

Working Conditions

Primary Work Environment

☒ Indoor/Office ☐ Member Facing ☐ Patient Facing ☐ Facilities/Security

Other Work Environment(s)

☒ Indoor/Office ☐ Member Facing ☐ Patient Facing ☐ Facilities/Security ☐ Outdoor Exposure

Hazards: General office hazards, which most commonly include potential physical and ergonomic hazards, such as falls, cuts, repetitive strains, accidents, etc.

Equipment: General office equipment

Travel: This position may include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Hybrid-Office 1 day/week

Current Health Share Employees: Please use the internal Workday site to submit an application for this job.

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. Health Share offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

Health Share is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.