Client Access & Benefits Navigator

Valley Cities Behavioral Health Care•Federal Way, WA

2d•Hybrid

About The Position

Valley Cities has recently been selected to lead efforts in Washington State to become a Certified Community Behavioral Health Clinic (CCBHC), reflecting compliance with stringent national standards in behavioral health care. This status enables broader service availability, improved integration of mental health and substance use treatment, enhanced crisis intervention capabilities, and ensures services are accessible to all, regardless of financial circumstances. We are excited about the future ahead! We’re looking for people who want to make a real difference in behavioral health while growing alongside a mission‑driven team. Employees joining Valley Cities at this time will become part of an impactful organization dedicated to advancing community behavioral health, that is grounded in compassion, equity and community impact. Join us to make significant contributions during pivotal moments in the lives of others! supportive and inclusive work environment. Join us in making a difference every day! The Client Access & Benefits Navigator helps Valley Cities clients obtain and keep the health coverage that makes their care possible and serves as the organization’s internal subject-matter resource on coverage requirements for clinicians and staff. Recent federal Medicaid legislation introduces more frequent eligibility redeterminations, community engagement (work) requirements for certain adult enrollees, expanded verification and documentation obligations, and new cost-sharing rules. These changes place significant administrative demands on a client population that includes people living with serious mental illness, substance use disorders, cognitive impairment, housing instability, and acute crisis — populations for whom a missed notice or an unreturned form can mean losing coverage and, with it, access to treatment. The Navigator works directly with clients to complete renewals, document exemptions, meet reporting deadlines, and respond to adverse determinations. The Navigator also equips clinical and front-office teams with the training, workflows, and documentation support they need to meet these obligations without diverting clinical time away from care.

Requirements

High school diploma or GED and two (2) years of experience in benefits navigation, eligibility determination, patient access, case management, community health work, or a closely related field. OR an associate or bachelor’s degree in social work, human services, public health, or a related field and one (1) year of such experience.
Working knowledge of Medicaid eligibility rules and enrollment processes, including Washington Apple Health.
Demonstrated ability to explain complex eligibility and regulatory requirements in plain language to individuals experiencing behavioral health symptoms, cognitive impairment, housing instability, or crisis.
Strong organizational skills and the ability to independently manage deadline-driven caseloads with a high volume of concurrent cases.
Proficiency with electronic health records and standard office software, including spreadsheets and document management.
Ability to work respectfully and effectively with people of diverse racial, ethnic, cultural, linguistic, gender, and socioeconomic backgrounds.
Valid Washington State driver’s license, reliable transportation, and proof of automobile insurance; ability to travel regularly between Valley Cities sites in King and Pierce Counties.
Ability to pass a criminal background check as required by Washington State Department of Health and Department of Social and Health Services regulations for positions with unsupervised access to vulnerable adults.

Responsibilities

Assist clients in gathering, completing, and submitting eligibility and renewal documentation, including income verification, residency, household composition, and disability documentation.
Support clients through Washington Healthplanfinder, Health Care Authority, and DSHS Community Services Office processes, including account setup, password recovery, document upload, and follow-up on pending determinations.
Identify reinstatement pathways for clients who have lost coverage, including retroactive coverage, good-cause reinstatement, appeals, and reapplication.
Conduct proactive outreach to clients approaching Apple Health redetermination deadlines, using multiple contact methods and coordinating with the client’s care team when standard outreach fails.
Assist clients who are ineligible for or transitioning off Medicaid for alternative coverage, including Qualified Health Plans with subsidies, Medicare, employer coverage, and Valley Cities’ sliding fee scale or charity care.
Coordinate with revenue cycle and billing staff on coverage lapses affecting active treatment episodes, prior authorizations, and medication access.
Educate clients on applicable community engagement (work) requirements, qualifying activities, reporting deadlines, and verification methods, adapting the explanation to the client’s cognitive, linguistic, and clinical presentation.
Screen clients for qualifying exemptions, including those tied to disability status, medical frailty, participation in substance use disorder treatment, caregiving responsibilities, pregnancy or postpartum status, and other exemption categories recognized under federal and Washington State rules.
Partner with clinicians and prescribers to obtain, complete, and submit clinical documentation supporting exemption determinations within required timeframes, drafting documentation for clinician review where appropriate.
Maintain a tracking system for client reporting deadlines and provide reminders, appointment scheduling, and hands-on assistance ahead of each reporting cycle.
Connect clients subject to engagement requirements to qualifying activities, including Valley Cities employment services and IPS Supported Employment, volunteer placements, education and job training programs, and community partner services.
Assist clients in responding to requests for information, notices of noncompliance, and termination or disenrollment actions, including preparing and submitting administrative hearing and appeal requests within filing deadlines.
Escalate cases involving imminent loss of coverage for clients in active or acute treatment to the supervisor and care team without delay.
Maintain working relationships with the Washington State Health Care Authority, Washington Health Benefit Exchange, DSHS Community Services Offices, managed care organizations, and community-based enrollment assisters.
Represent Valley Cities in regional coalitions, learning collaboratives, and workgroups addressing coverage access for behavioral health populations.
Contribute frontline observations and aggregate data to organizational advocacy efforts on behalf of clients affected by coverage policy changes.
Maintain timely, accurate, and complete documentation of all client contacts, coverage status, exemption determinations, and deadlines in the electronic health record and designated tracking tools.
Produce recurring reports on coverage retention, disenrollment volume and cause, reinstatement outcomes, and at-risk caseloads for department and executive leadership.
Contribute data to quality reporting, grant reporting, board reporting, and organizational dashboards as requested.
Support internal and external audits, chart reviews, and quality improvement activities related to access and coverage.

Benefits

Medical, Dental, & Vision coverage available for employees and eligible family members and dependents
Health Savings Account, $2,000 contribution annually, prorated monthly.
Agency sponsored retirement plan, up to 6% employer contributions, and pre-tax/Roth available
Access to Employee Assistance Program (EAP) resources
Comprehensive paid time off, paid holidays, and extended sick leave options
Access to Student Loan Forgiveness Programs
Annual longevity bonuses
Recognition programs and incentives
Access to training, supervision, and consultation for professional certification and licensure
Clinical supervision provided toward licensure, if applicable
Paid training days and yearly training fund