Insurance Navigator/Medicaid Redetermination

FAMILY HEALTH CARE CENTER OF KALAMAZOO•Kalamazoo, MI

4d•Hybrid

About The Position

The Insurance Navigator / Medicaid Redetermination Specialist plays a critical role in ensuring continuity of care for patients served by Family Health Center by providing comprehensive insurance navigation, eligibility assistance, and Medicaid redetermination support. This position serves as a trusted resource for patients and families, helping them understand and maintain health coverage while reducing coverage gaps that could disrupt access to care. The Navigator works collaboratively with clinical, financial, and community partners to support patients through Medicaid redetermination, Marketplace enrollment, and other public insurance programs, with a strong emphasis on health equity, cultural humility, and patient advocacy. They collaborate with financial counselors, community health workers, and customer experience technicians to coordinate patient enrollment in Medicaid or Marketplace coverage. They assist in gathering required documentation for initial enrollment and redetermination to help ensure patients maintain adequate coverage and access to the full range of services offered at Family Health Center. They also monitor and evaluate available options to support and optimize each patient’s oral health outcomes. These individuals will serve as gatekeepers to our various communities in the Kalamazoo service area and will support various outreach initiatives with local churches, community and civic organizations, housing complexes, school systems, and other organizations where our patient population may frequent.

Requirements

Minimum of 1 – 2 years of experience in community mobilization, outreach, insurance navigation, Medicaid eligibility, patient access or social services preferred.
Strong interpersonal, communication and organizational skills
Ability to work effectively with diverse populations and demonstrate cultural humility
Viewed as a trusted member of the community
Proficiency with electronic health records and state eligibility systems preferred.
Bilingual or multilingual skills are strongly preferred
Certification as a Certified Application Counselor (CAC) or willingness to obtain within a specified timeframe preferred.
Experience working in a federally qualified health center, social services, or safety-net environment.
Demonstrates customer focused interpersonal skills to interact in an effective manner with practitioners, interdisciplinary health care team, community agencies, patients/families with diverse opinions, values as well as religious and cultural beliefs.
Demonstrates excellent written, verbal/listening skills.
Demonstrates positive relationship building skills and critical analysis skills.
Demonstrates ability to work autonomously and be accountable for practice.
Demonstrates ability to influence and negotiate individual and group decisions.
Demonstrates ability to function in a fluid, dynamic, changing environment.
Must have reliable transportation and valid driver's license to travel to office locations or other locations as assigned.

Nice To Haves

Minimum of 1 – 2 years of experience in community mobilization, outreach, insurance navigation, Medicaid eligibility, patient access or social services
Proficiency with electronic health records and state eligibility systems
Bilingual or multilingual skills
Certification as a Certified Application Counselor (CAC) or willingness to obtain within a specified timeframe

Responsibilities

Serve as the primary point of contact for patients undergoing Medicaid redetermination, ensuring timely completion and submission of renewal applications.
Proactively identify patients at risk of losing Medicaid coverage and conduct outreach via phone, mail, text, or in-person engagement.
Assist patients with completing Medicaid renewal forms, providing required documentation, and navigating state eligibility systems.
Educate patients on renewal timelines, eligibility requirements, and potential outcomes of redetermination.
Track renewal status and follow up to prevent lapses in coverage.
Provide enrollment assistance for Medicaid, CHIP, and Affordable Care Act (ACA) Marketplace plans when Medicaid eligibility changes.
Support transitions between coverage types, ensuring patients understand plan benefits, costs, and provider networks.
Assist uninsured or underinsured patients in identifying appropriate coverage options and financial assistance programs.
Maintain certification as a Certified Application Counselor (CAC) or equivalent, as required.
Deliver clear, culturally responsive education on insurance benefits, patient rights, and responsibilities.
Advocate on behalf of patients with state Medicaid offices, Managed Care Organizations (MCOs), and insurance carriers when appropriate.
Support patients facing language, literacy, or technological barriers to enrollment and redetermination.
Partner with clinical staff, care coordinators, case managers, and billing teams to align insurance coverage with care delivery.
Participate in interdisciplinary team meetings to identify patients with coverage-related care barriers.
Coordinate with community-based organizations and state agencies to support patient access to coverage.
Accurately document patient interactions, applications, and outcomes in the electronic health record (EHR) and eligibility systems.
Track key performance indicators related to Medicaid retention, coverage continuity, and successful renewals.
Ensure compliance with HRSA, CMS, and state Medicaid requirements, including privacy and confidentiality standards.
Support audits, grant reporting, and quality improvement initiatives related to insurance coverage and access to care.
Other duties as assigned.