Health Benefits Navigator

Brief Description

Lowell Community Health Center (Lowell CHC) is a diverse, community-based health care organization. Our programs have been recognized as national models and Lowell CHC was named one of the top five health centers in the nation for excellence in cultural competency. With a career at Lowell CHC, you will be joining a dynamic team of passionate and talented people.

JOB SUMMARY:

The Health Benefits Navigator serves as the primary resource for patients who need assistance with insurance enrollment, eligibility verification, prior authorization, and payment options. This role helps patients understand coverage, apply for insurance, and navigate self-pay or financial assistance options. Navigators also have authority to schedule appointments, collect payments, and verify insurance to ensure a seamless experience without unnecessary handoffs. The position combines patient advocacy, education, and operational support to improve access to care and financial stability.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Essential duties and responsibilities include the following. Additional duties and responsibilities may be assigned as deemed necessary.

Essential

Insurance Education, Application, & Retention:

• 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.
• Assist with insurance applications via state systems or paper forms.
• Conduct follow-up to ensure enrollment completion and support retention of coverage.
  
  

Insurance Verification

• Verify insurance coverage, effective dates, PCP assignment for ACO patients, co-pays, and benefits in electronic health records (EHR) and make updates as needed
  
  

Payment & Financial Counseling:

• Provide information about financial assistance program options, including sliding fee scale.
• Educate patients on payment plans and self-pay options.
• 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.

Additional

Appointment Scheduling:

• Schedule, reschedule, or cancel appointments as needed.
• Ensure accurate data entry in the EHR system.
  
  

Community Outreach:

• Represent the organization at community events and health fairs, providing culturally appropriate education.
• Document outreach activities and participant engagement.[GV1] [HE2]
  
  

Billing Support:

• Support patient accounts team with ad hoc billing issues.
  
  

Customer Service & Collaboration:

• 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).
  
  

Collaboration and Teamwork:

• Attend and participate in trainings, webinar and conference calls to stay current on State/Lowell CHC organizational changes and updates.
• Complete reports when required.
• Provide cross-coverage and staff training as needed.
• Identify problem and situations within the department and be part of the solution/ provided input and suggestion.
• Complete Navigator Certification training within the first month of hire and completed yearly renewal.
  
  

QUALIFICATIONS:

• 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.
  
  

WORK ENVIRONMENT:

Frequent contact with patients, families, visitors, nurses and other department staff. Occasional requests to change work areas to cover another priority area to meet patient needs. Occasional stress and pressure caused by multiple simultaneous demands. May be exposed to various infectious diseases. Universal precautions and techniques are included in orientation, and the availability of protective wear is supported and encouraged when the employee is at risk of exposure.