Benefits Navigator

Family Health Center of Marshfield Inc

13d

About The Position

The Benefits Navigator is responsible for conducting outreach, education, and enrollment related to the Health Insurance Marketplace and Medicaid programs. Under the guidance of leadership, this individual will perform a variety of tasks to support the operational functions of the prepaid healthcare program. Responsibilities include screening individuals, providing health benefits counseling, conducting interviews, determining eligibility, and facilitating enrollment for membership. The Benefits Navigator will collaborate with internal and external stakeholders to assist members in resolving issues and ensuring access to appropriate healthcare coverage.

Requirements

High school diploma or equivalent.
Two years of experience as a Certified Application Counselor or Navigator for the Health Insurance Marketplace, with demonstrated knowledge of enrollment policies, procedures, and appeals preferred.
Two years of experience in a medical/business office, health insurance, public agency, or social program setting.
Demonstrated proficiency in customer service, with effective verbal, non-verbal, and written communication skills.
Proficiency in Microsoft Office Suite.
Knowledge of basic business math principles, including calculations and percentages with ability to interpret financial statements and tax returns.
Certified Application Counselor (CAC) designation through the Centers for Medicare and Medicaid Services required within three months of the first available CAC training period after hire. Employees hired fewer than three months prior to the CAC training period may defer certification until the following year. A maximum of three attempts to pass the CAC exam is permitted within three months of completing training. Failure to pass may result in termination, except in cases of extenuating circumstances.
Valid Wisconsin Driver’s License required with an acceptable motor vehicle record (MVR), per FHC guidelines.

Nice To Haves

Preferred Wisconsin Accident/Health Insurance Agent License.

Responsibilities

Provides outreach and education on the Health Insurance Marketplace and state Medicaid programs to consumers and organizations within the Family Health Center’s (FHC) service area and neighboring communities.
Facilitates enrollment in Health Insurance Marketplace or Medicaid programs by assisting individuals throughout the application and enrollment process.
Supports individuals with Marketplace and Medicaid appeals to ensure timely and accurate resolution.
Screens prospective individuals to assess eligibility for FHC programs and guide them through the enrollment process based on program guidelines.
Conducts interviews with prospective members to explain covered benefits, member responsibilities, and determine eligibility and premium levels in accordance with FHC program requirements.
Educates members on available healthcare coverage options, as well as applicable government and community assistance programs.
Delivers high-quality customer service in resolving concerns related to eligibility, benefits, and claims for current members, prospective applicants, and providers.
Verifies member eligibility and adjusts program fees based on reported changes; negotiates and establishes payment plans as appropriate.
Conducts audits of member accounts to verify continued eligibility, assess accuracy of program fees, and reconcile unreported changes.
Initiates payment reminder calls, negotiates payment arrangements, and coordinates program fee assistance based on individual needs.
Advises members transitioning to Medicare on enrollment steps, including application for Part B and referral to Medicare Premium Assistance, Low Income Subsidy (Part D), and/or SeniorCare programs.
Investigates and verifies primary insurance coverage to ensure accurate coordination of benefits.
Assists with internal and external audits to ensure proper use of grant funding and compliance with indigent drug program requirements.
Processes program fee payments to support accurate and timely fee collection for FHC programs.
Maintains strict adherence to scheduled work hours with regular and reliable attendance.
Performs other duties as assigned.