Benefits Navigator

Job Summary:

The Benefits Navigator position is responsible for raising awareness of affordable insurance options and providing eligibility and enrollment assistance to uninsured patients of Mazzoni Center. This includes enrolling patients in public benefits, including but not limited to: Medicaid/MAWD/ Emergency Medical Assistance; Medicare Extra Help/Medicare Savings Program; SNAP; LIHEAP; CAP/CRP; PACE/PACENET; Home Waiver IEB; Hospital Financial Assistance/Charity Care; Property Tax/Rent Rebates. Additionally, the Benefits Navigator is responsible for helping patients navigate their financial responsibilities and understand insurance processes.

Key Responsibilities:

• Assess uninsured patients' potential eligibility for Pennsylvania Medicaid, CHIP and/or affordable insurance coverage, complete Medicaid applications, and complete applications on the affordable insurance exchange (Pennie) where applicable.
• Assess patients' potential eligibility for other benefits (LIHEAP, SNAP, etc.) and offer help obtaining them.
• Collect necessary documentation for benefit enrollments and update collected insurance information in the EMR.
• Assist patients receiving an insurance plan for their specific needs and to receive optimal coverage.
• Review explanation of benefits (EOB) with patients to clarify insurance coverage and financial obligations.
• Assist patients in understanding medical bills, including out-of-pocket costs, copayments, deductibles, and coinsurance.
• Provide guidance on insurance claims, appeals, and reimbursement processes.
• Collaborate with healthcare providers and internal departments to resolve financial issues and ensure a seamless patient experience.
• Facilitate warm hand-offs to internal and external services, including social workers and community resources.
• Maintain accurate and confidential patient records.
• Stay updated on changes in healthcare laws, regulations, and insurance policies.

Education, Training, License and Certification, Skills and Experience:

• Bachelor's degree preferred (candidates without bachelor's degree but who demonstrate experience and expertise in obtaining health insurance benefits for patients may be considered).
• Previous experience in financial counseling, healthcare billing, or patient advocacy preferred.
• Pennie Certification and COMPASS enrollment required
• Strong understanding of insurance terminology and billing processes.
• Excellent communication skills, with the ability to explain complex financial information clearly.
• Empathetic approach to assisting individuals with diverse backgrounds and financial situations.
• Proficiency in computer applications and software.
• Ability to work independently and collaboratively in a fast-paced environment.
• Commitment to maintaining confidentiality and ethical standards.

Clearances

• Background checks are required, including Criminal Background Clearance, Child Abuse Clearance, and FBI Clearance.
• Must complete Mazzoni Center Credentialing and Privileging to provide direct services as a Federally Qualified Health Center LAL.

Physical Requirements:

1. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met;
2. Kneeling, bending legs at knee to come to a rest on knee or knees Crouching. Bending the body downward and forward by bending leg and spine;
3. Reaching. Extending hand(s) and arm(s) in any direction;
4. Walking. Moving about on foot to accomplish tasks, particularly for long distances or moving from one work site to another
5. Talking. Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly;
6. Hearing. Perceiving the nature of sounds at normal speaking levels with or without correction. Ability to receive detailed information through oral communication, and to make the discriminations in sound;
7. Repetitive motion. Substantial movements (motions) of the wrists, hands, and/or fingers.
8. Exerting up to 35 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body.

Mazzoni Center is committed to the principles and practice of equal employment opportunity and to the full inclusion of all qualified individuals. As part of this commitment, consistent with the Americans with Disabilities Act, the Pennsylvania Human Relations Act, and the Philadelphia Fair Practices Ordinance, it is Mazzoni Center’s policy to provide reasonable accommodation to perform the essential functions of this position when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship.