Patient Navigator (Bilingual English/Spanish required)

Kinston Community Health•Kinston, NC

2h•$16 - $19

About The Position

The Patient Navigator assists patients in accessing and maintaining health insurance coverage through Medicaid and ACA Marketplace programs. The role provides enrollment assistance, coverage verification, application follow-up, and help navigating barriers to care. It also provides backup lobby assistance, conducts assigned insurance and Sliding Fee Discount Program (SFDP) audits, and collaborates with Registration and other departments to promote accurate documentation, regulatory compliance, and access to healthcare services. The position requires a high school diploma or GED and bilingual English/Spanish skills. Marketplace assister training and authorization must be completed before performing regulated activities; a Certified Application Counselor or other authorized application-assister designation is subject to organizational and program approval. One to two years of relevant experience is preferred. The Patient Navigator works in clinical and office settings, may work nights and weekends as departmental needs arise, and has no direct supervisory responsibilities. The role serves as a knowledgeable resource to staff regarding assigned programs and processes.

Requirements

High school diploma or GED required.
Bilingual English/Spanish skills required.
Complete applicable Marketplace assister training and authorization before performing regulated activities.
Certified Application Counselor or other authorized application-assister designation, subject to organizational and program approval.
Working knowledge of North Carolina Medicaid, Medicaid managed care, and ACA Marketplace coverage.
Strong communication, customer service, organizational, follow-up, and independent-work skills.
Ability to assist with online applications and documentation.
Proficiency with electronic health record and insurance verification systems.
Ability to protect confidential information while working in a busy lobby.
Ability to work nights and weekends as departmental needs arise.
Must pass required background checks and comply with organizational credentialing and screening requirements.
Ability to meet the stated physical demands, including prolonged sitting and computer use, frequent hand and finger use, close visual acuity, occasional standing and walking, and occasional movement of materials weighing up to 25–50 pounds.

Nice To Haves

One to two years of healthcare registration, patient access, Medicaid eligibility, insurance verification, or benefits assistance experience preferred.

Responsibilities

Assist patients with Medicaid eligibility verification, applications, renewals, and supporting documentation.
Help patients navigate ACA Marketplace enrollment, identify potential coverage options, and complete applications within authorized training and certification requirements.
Follow up on pending applications, unresolved coverage concerns, and potential gaps in insurance coverage.
Provide backup lobby assistance by greeting patients, directing them to appropriate departments, and identifying those who need enrollment or coverage assistance.
Maintain accurate documentation of patient assistance, application status, follow-up activities, and confirmed coverage changes in approved systems.
Coordinate with Registration and the Sliding Fee Discount Program to resolve coverage concerns and ensure appropriate follow-up.
Conduct weekly audits of selected PSR encounters and Access/Registration applications to identify insurance accuracy, documentation, and eligibility verification issues.
Conduct monthly audits of SFDP applications for completeness, income calculations, assigned discount levels, and effective and expiration dates.
Document audit findings, communicate discrepancies to leadership, coordinate corrective-action follow-up, and identify opportunities for process improvement.
Prepare weekly activity and audit reports, including patient assistance, enrollment activity, audit findings, outstanding corrections, and follow-up needs.
Maintain HIPAA compliance, protect confidential patient information, and follow applicable organizational policies and procedures.
Follow workplace safety standards and infection control policies when present in clinical environments.
Perform additional duties as assigned to support organizational goals.
Promptly report known or suspected violations of compliance or safety standards and comply with organizational policies, applicable laws, credentialing, screening, and background-check requirements.