ACA- OE Navigator
POSITION SUMMARY: Seeking a bilingual- Spanish speaking candidate. Will be responsible for working directly with each patient to assess their financial situation, identify available insurance options, and provide any needed enrollment assistance. Manages financial risk to SJMCS by determining payor and securing all unscheduled patient accounts. Secures accounts by verifying benefits, including grants eligibility and obtaining authorization as needed from third party payers to ensure reimbursement for services rendered. Investigates all information for validity and accuracy. Follows developed policies and procedures to obtain and verify financial information, insurance benefits and authorization. Identifies correct insurance plan, financial class, and coordination of benefits. Contacts third party payers for insurance benefits to verify eligibility and initiates authorization for services. Develops a financial plan for uninsured patients by securing payment or payment plan. Collaborated with appropriate personnel for Medicaid screening and/or qualifying for financial assistance. Calculates deductibles, co-payments, and cost estimates. Collects patient payment or co- payment at time of visit. Interprets patient bills and problem solves billing issues to resolution. Prioritizes work for optimal reimbursement and to avoid financial risk to both patient and clinic. Supports activities of Registration by documenting accurate patient income or insurance, and collection information. Efficiently and effectively uses EPIC practice management system, multi- tasking skills, and use of office equipment expected.
*Provides patient care and/ or support activities appropriate to ages served; primarily adults ages 18-65 or geriatric patients ages over 65. May also include care for infant age 0-1 year, child ages 1-12 years or adolescent ages 13-17 years.
EDUCATION REQUIREMENTS: High school education diploma or equivalent. Associate's or Bachelor's Degree preferred. CPAR certification optional. Navigator license through Georgia Insurance Department or be able to obtain within 60 days of hire.
EXPERIENCE REQUIREMENTS: Two (2) years minimum of work experience in financial counseling in a healthcare setting or equivalent. Computer experience; previous EPIC EPM system experience preferred.
JOB KNOWLEDGE: Basic knowledge of third party payer requirements, government programs and grants (latter can be learned on the job if person has other knowledge and experience required for financial counseling). Computer skills required. Must be detail oriented and demonstrate strong communication, interpersonal and customer service skills.