PATH Navigator- Financial Access

SUMMARY

The PATH Navigator – Financial Access serves as WCHC’s primary financial navigation professional, guiding patients and families through complex insurance, coverage, and financial assistance decisions that impact access to care. This role is responsible for interpreting insurance benefits, estimating patient financial responsibility, and evaluating whether Medicaid enrollment, charity care, sliding fee discounts, or alternative financial arrangements are the most appropriate pathway based on each patient’s circumstances. The PATH Navigator exercises independent judgment and discretion on matters of significance related to patient financial access, balancing patient advocacy with regulatory compliance and organizational policy. As a key member of the interdisciplinary PATH team, the role collaborates closely with inpatient case management, social work/discharge planning, and outpatient care coordination to proactively identify and resolve financial barriers, support informed patient decision-making, and promote timely access to medically necessary services.

To perform this job successfully, an individual must be able to perform each responsibility satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability to be successful.

DUTIES/RESPONSIBILITIES (include but are not limited to the following)

• Serve as the primary financial navigation resource for patients across inpatient, outpatient, and emergency department settings.
• Analyze insurance benefits, coverage limitations, deductibles, co-insurance, out-of-pocket maximums, referral and authorization requirements to develop individualized cost estimates.
• Independently assess patient financial and coverage circumstances to determine the most appropriate financial pathway.
• Guide patients through Medicaid application and approval processes, including eligibility interpretation and documentation support.
• Screen, educate, and assist patients with WCHC financial assistance, charity care, and sliding fee programs.

EDUCATION AND/OR EXPERIENCE

• Bachelor’s degree preferred in healthcare administration, business administration, finance, social services, or related field.
• Three (3) to five (5) years of experience in healthcare financial counseling, insurance navigation, revenue cycle, or care coordination.
• Experience exercising independent judgment in patient financial assessment.
• Experience collaborating with interdisciplinary healthcare teams.
• Epic or comparable EHR/financial system experience preferred.

SKILLS AND ABILITIES

• Demonstrated expertise in commercial insurance, Medicare, and Medicaid benefit interpretation.
• Working knowledge of Medicaid eligibility and healthcare financial assistance programs.
• Strong understanding of healthcare billing regulations and compliance standards.
• Bilingual (English/Spanish) preferred.