Care Navigator

Independent Health•Buffalo, NY

1d•Onsite

About The Position

The Care Navigator is the first point of contact for all member and provider inquiries. The Care Navigator is a professional who displays confidence, a passion for health and wellness, and practices empathetic listening in every interaction. The Care Navigator provides high touch assistance to members in areas such as benefit questions, provider selection, health improvement, identification of care resources, and facilitation of benefit utilization, such as assisting members with appointment scheduling, and preparing for medical appointments. Care navigators find creative solutions to overcome member barriers. While some members follow the path of the typical healthcare consumer, others have unique needs that require initiative and creative thinking to locate the appropriate resource. Other duties may also include, closing gaps in care, assisting with appointment scheduling, and communicating with providers to deliver the best customer care experience we can.

Requirements

High School Diploma or GED required.
Six (6) months of customer service experience required.
Desire to positively impact our members’ health coverage experience through empathetic listening and high touch experience.
Ability to build cohesive relationships, solve problems, and support our members by providing them resources and education that promote their ability to navigate a complex healthcare system.
Must be adaptable and thrive in a high energy, creative, and evolving work environment.
Ability to handle multiple duties with minimal direction and apply critical thinking skills and make decisions based upon individual needs.
Excellent interpersonal, verbal and written communication skills.
Microsoft Office proficient.
Computer skills that include but are not limited to Word, Excel, Power Point and ACT.
Proven examples of displaying Nova’s Core 4: Act with Passion, Work Together, Be Accountable, Build Trust.

Nice To Haves

Experience in a healthcare related or social services setting preferred.

Responsibilities

Responsible for acting as a customer advocate by demonstrating active listening skills to fully understand the scope of the customer’s needs.
Efficiently navigate through systems and applications to locate information specific to the customer inquiry. These inquiries may include, but are not limited to: Benefit, eligibility, provider billing and complex claim inquiries.
ID card requests.
PCP Assignment and provider searches.
Prior-authorization status and management.
Out-of-network redirection and negotiation awareness.
Case and disease management referrals.
Repatriation.
Member website, app and portal assistance.
Appointment scheduling.
Contractual and clinical appeals.
COB/Dependent verification.
Subrogation calls.
Interdepartmental call flow response standards
Ensure that our members/employers are obtaining accurate and up-to-date information on policies and procedures and communicate a successful resolution to inquiries.
Ensure compliance with all DOL rules and regulations.
Build trusting relationships with customers using an empathetic and compassionate approach.
Effectively solve problems utilizing critical thinking skills.
Accurately read, interpret, and apply appropriate information to each customer interaction.
Identify opportunities to educate customers by providing tools and resources to make informed decisions.
Meet or exceed all department standards in the following categories as measured and recorded in the representative’s scorecard.
Log all contacts into appropriate systems.
Maintain technical knowledge regarding benefit plan documents.
Attend all required training sessions.
Address first level complaints and aid with appeals as needed.
Effectively resolve inquiries from customers regarding claims, benefits, eligibility, and reimbursement.
Maintain knowledge of all pertinent systems and the ability to coordinate the use of these tools at the same time.
Working knowledge of Nova’s policies and procedures to include departmental policies and procedures based on the line of business being served.
Other duties as required by direct management which may include but may not be limited to servicing walk-in members, and correspondence support.
Mentor new Care Navigation associates.