Public Health Patient Access Navigator

POSITION SUMMARY:

This position is a special role designed for the grant-funded Public Health programs. This position is designed to ensure that all patients seen under the Public Health programs have consistent access to healthcare coverage. The Public Health Patient Access Navigator will advocate for the patient and support the patient through financial and insurance related challenges during their treatment, including assisting the patient in applying for financial assistance programs and helping the patient secure healthcare coverage. As a Certified Application Counselor, the Public Health Patient Access Navigator (PAN) will assist patients presenting for Public Health services, by appointment or walk-in, and will screen for eligibility and offer enrollment assistance to secure insurance coverage through MassHealth, Out of State Medicaid, HSN, or BMC’s Charity Care Program. The PAN is responsible for initiating new applications and assisting with program renewals; for educating patients about health insurance options and eligibility requirements; and for updating patient demographic information, opening financial trackers, and documenting all efforts made to assist patients in applying for insurance coverage. The PAN will embody BMC’s mission, vision, and values and follow policy and procedure regarding BMC’s billing and collection practices and the Certified Application Counselor Designation Agreement between BMC and MassHealth.. The PAN will work closely with clinic providers and staff to identify and assist any patients who may need enrollment or reenrollment support. Additionally, they will collect data for program evaluation, conduct chart reviews in the EMR, track data and follow-up with relevant parties. The PAN will conduct all activities within the standards and regulations of the Massachusetts Department of Public Health (DPH), Center for Disease Control and Prevention (CDC), Boston Public Health Commission (BPHC) and any other funders.

Position: Public Health Patient Access Navigator

Department: Infectious Diseases

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Links HIV+ and STD Clinic patients into necessary insurance plans, HDAP or other benefits to ensure ongoing medical care and other services.
  • Completes MassHealth’s curriculum for Certified Application Counselor and renews certification annually.
  • Interviews patients (utilizing an interpreter if needed), in a language and manner best understood, to determine eligibility and communicate enrollment options and plan benefits for which patients qualify. Answers questions about Qualified Health Plans (QHP) and Qualified Dental Plans (QDP). Explains subsidized Qualified Health Plans available through premium tax credits or informs patients of expected out-of-pocket expenses, co-pays, and deductibles when applicable.
  • Utilizes protected software programs to determine patient eligibility for MassHealth, Health Safety Net, ConnectorCare, and other insurance carriers and assists with enrollment process.
  • Provides assistance to Public Health Program patients including conducting outreach and education, initiating new applications or plan renewals for health insurance coverage. Informs patients of important deadlines, effective dates for coverage, and required documentation to determine eligibility.
  • Scans MassHealth applications and supporting verification documents into HIX and patients’ Epic record.
  • Documents in Epic the status of all applications initiated by adding a financial tracker and recording actions taken and follow-up efforts required to complete and submit for processing.
  • As requested, assists patients with enrolling in an ACO or changing selection of ACO, to ensure continued access to covered services.
  • Provides voter registration information and registration assistance as needed; completes appropriate patient declination form for applicants as requested.
  • Validates and updates active insurance coverage in the hospital registration and billing system on accounts with covered dates of service.
  • Assists patients with billing questions or concerns. For patients deemed ineligible for financial assistance programs, provides information regarding self-pay discount and payment plan options.
  • Collects and posts payments for balances related to self-pay, Ad-Hoc, and Flat Fee contracts in accordance with BMC policy and procedure for collection practices.
  • Interacts with numerous departments to resolve insurance and billing questions e.g., Customer Service, Pharmacy, Social Service, Case Management, Patient Accounts ,Clinic Staff, Unit Nursing staff, professional billing etc.
  • Understands and adheres to rules established by the BMC Credit and Collection Policy.
  • Assists patients with confidential applications for protected services, adding account notes to notify others of the patient’s protected status.
  • Assists patients with medical hardship and confidential applications, obtaining and submitting verification documents and applicable medical bills required to apply and make a determination of eligibility.
  • Responds to telephone calls in a courteous manner. Responds promptly to all inquiries from staff, patients, and general public. As needed, refers callers to other departments or resources deemed appropriate for resolution.
  • Presents and interacts respectfully and professionally with BMC patients, visitors, and other team members; works cooperatively and respectfully with other departments and disciplines across the organization.
  • Serves as a resource and subject matter expert regarding financial assistance programs. Provides education and advisement on health insurance options and enrollment requirements for other hospital departments, community health centers, community leaders and other personnel as needed.
  • Validates and/or updates demographic and income information in HIX portal for “known” patients with prior history of program eligibility.
  • Validates patients’ active insurance coverage and updates current plans in Epic.
  • Collects and posts payments on accounts with outstanding balances. Maintains and closes Epic Cash Drawer and documents transactions in patients’ financial trackers.
  • Schedules tasks for Financial Counseling Enrollment Coordinators, (FCECs) to conduct patient follow-up on pending applications to ensure that required documents are obtained and applications are completed and submitted timely to secure retroactive coverage.
• Become expert in the regulations and processes involved in HDAP, other insurance and benefits for HIV/AIDS patients to serve as information resource to patients and medical staff regarding benefits
• Resolves billing problems on behalf of patients
  • Answers inquiries from patients, clinic providers and staff and/or third party payers and follows through to resolution.
  • Interprets and explains to patients and their families the charges, services and policies regarding payment of bills.
  • Provides information about the full range of medical and dental insurance programs available through the Health Insurance Exchange (HIX).
• Work closely with the Medical Case Managers and Prevention staff as member of the team
• Verifies mental health and/or substance abuse benefits, obtains initial authorization as determined by medical plan/insurance.
• Implements tracking system to track reenrollment of coverage, benefits and services as needed
• Refers patients to financial resources for completion of applications for medical assistance. May need to accompany patients.
• Write accurate notes in the BMC EMR and in the other tracking systems for a specific contracts
• Follows-up with relevant providers as needed
• Responding to the EMR messaging system in a timely manner
• Must be able to write and communicate in a professional manner appropriate to a major hospital
• Has a knowledge of HIV/HCV/STIs and able to communicate appropriate information to patients and providers
• Collects data as needed for program evaluation. Conducts data entry and tracks it through an internal data system and any specific mandated systems, including the BMC EMR
• Collects all programmatic data
• Respond in a timely manner to deadlines and program management
• Responsible for following up on any cases until there is a resolution
• Tracks and monitors referral from various client referrals sources.
• Attends staff meetings and communicates progress and problems to program leadership. Attends clinical supervision staff support group. Participate in CDC/MDPH/BPHC trainings and meetings with other grantees if requested.
• Remains knowledgeable of, and follows, appropriate policies, procedures, and work standards, including but not limited to, those regarding hours of work, absenteeism, and tardiness.
• Maintains competency in appropriate areas of responsibility to ensure quality of care. Maintains patient confidentiality; is comfortable handling sensitive personal information. Follows established hospital infection control and safety procedures
• Utilizes hospital values as basis for decision making and to facilitate BMC missions. Models the ability to set professional boundaries.
• Performs other duties as assigned or as necessary.

Must adhere to all of BMC’s RESPECT behavioral standards.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

EDUCATION:

• High School diploma
• Bachelor's degree strongly preferred.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• Must complete MassHealth’s curriculum for Certified Application Counselor, (CAC) and maintain certification renewal annually. Individual must complete training and obtain CAC certification within 45 days of hire date.

EXPERIENCE:

• Work experience to include 2-3 years of strong customer service experience, preferably in a healthcare or human services setting;

KNOWLEDGE AND SKILLS:

• Demonstrates professionalism, maturity, and confidence needed to work effectively in a diverse, multi-cultural, and decentralized environment.
• Displays strong, consistent communication skills, (oral and written), interpersonal skill, and record keeping skills.
• Demonstrates knowledge and understanding of eligibility criteria and application process for programs offered through MassHealth, Health Safety Net, ConnectorCare, and BMC’s Charity Care Program.
• Displays strong organizational skills with ability to manage multiple tasks simultaneously; prioritize work assignments appropriately; and complete follow up task timely.
• Demonstrates strong work ethic and ability to meet performance goals for productivity and outcomes with minimal direct supervision.
• Demonstrates critical thinking and sound judgment in addressing and resolving barriers, issues, or concerns identified.
• Requires strong technical computer skills and proficiency in utilizing Epic and external database systems to research cases and successfully assist patients in securing active coverage.
• Displays exceptional customer skills and the ability to engage patients, family members, and team members respectfully, with empathy and cultural sensitivity.
• Bilingual persons and persons with hospital and/or healthcare experience strongly preferred

Equal Opportunity Employer/Disabled/Veterans