INSURANCE HELPLINE NAVIGATOR BILINGUAL

About Whitman-Walker

Whitman-Walker envisions a society where all persons are seen for who they are, treated with dignity and respect, and afforded equal opportunity to health and wellbeing. Through care, advocacy, research, and education, we empower all persons to live healthily, love openly, and achieve equality and inclusion. For over 50 years, we have been meeting the needs of our communities with the endless dedication of our diverse teams.

Job Summary

The Insurance Helpline Navigator Bilingual role helps patients and DC, MD, and VA residents with health insurance and public benefits eligibility, enrollment, and literacy - connecting people to Medicaid, Medicare, Qualified Health Plans on the exchange, subsidies, other insurance opportunities, and public benefits. This position is a specialized entry-level position to support the PBIN team and facilitate patient and consumer access to insurance coverage and troubleshooting issues. Responsible for the Insurance Helpline, scheduling and connecting patients/clients to PBINs for assistance, insurance verification, triaging issues, and other tasks as assigned. Navigators have been on the front lines of implementation of health reform as certified DC Health Link Assisters and providing critical consumer outreach and enrollment assistance to uninsured and under-insured DC, MD, and VA residents.

Core Whitman-Walker Primary Essential Duties:

• Performs and behaves in accordance with Whitman-Walker’s mission, cultural norms, and core values of dignity, respect, affirmation, and humility.
• Maintain a respectful, non-judgmental, and compassionate manner with patients/clients/staff.
• Demonstrate excellent customer service by identifying and exceeding customer requirements.
• Adhere to Whitman-Walker policies and procedures, with special attention given to HIPAA requirements.
• Maintain data integrity through conscientious use of relevant tools and employing a system of checks and balances.
• Demonstrate organizational skills necessary to multi-task, meet deadlines, and re-prioritize as needed.
• Participate in organizational quality and performance improvement activities.
  
  

Role Specific Primary Essential Duties:

• Responds promptly to internal insurance verification inquiries, telephone encounters, internal referrals, and internal systems to track public insurance coverage assignments.
• Serves as a point of contact for questions from PBINs and staff about connecting consumers and staff to PBIN services and information about eligibility for insurance and programs to assist consumers.
• Operates as backup PBIN when needed.
• Resolves issues impacting patient health billing on insurance claims that were denied claims or require additional information to successfully bill (i.e.: Third Party Liability (TPL), Insurance Pending, Insurance Needed, etc.), as assigned.
• Update client information and upload documents into WWH’s electronic medical record system and online Legal Services database, as needed.
• Supports the Insurance Helpline by answering the Insurance Helpline, responding to consumer and staff inquiries about eligibility, benefits/coverage, application requirements, and renewal procedures as well as needed documentation to get and keep health insurance. In addition, helps to identify any barriers to care and understand what other services they may need at Whitman-Walker and how PBIN can help them achieve their care goals.
• Navigators are expected to efficiently handle calls on the PBIN (Public Benefits and Insurance Navigation) Insurance Helpline, prioritizing client needs and resolving the clients' concerns. Navigators are expected to exhibit a customer-centric approach in a timely manner. Navigators are expected to maintain a call answer rate and a missed call rate close to the department average.
• Uses internal systems to track public insurance coverage assignments and notifies billing of any Insurance updates to process outstanding claims.
• Works with the Insurance Helpline Specialist or Senior Insurance Helpline Specialist to monitor and report call and schedule volume to management and recognize general trends in the type of issues being presented, create interventions, and identify team responsiveness to assist management with ensuring high quality, efficient delivery of services and capacity.
• Participates in yearly Part D open enrollment working with legal services to support our client’s medication needs.
• Handles troubleshooting of routine enrollments and eligibility and coverage issues with support from managers, Senior Specialist, or Specialists, when needed.
• Manages the tracking of clients' applications in Legal Server and advocates as necessary.
• Supports management and the team in centralizing procedures that assist the team to ensure that public insurance applications and benefits are completed timely and accurately, including obtaining signatures facilitating the completion of clinical information from medical staff, and completing data entry, among other needed tasks.
• Observe trends and other operational issues impacting the delivery of efficient service and report on them to management and through team meetings.
• Coordinates and communicates with patient health billing to ensure accurate and timely processing of complex claims and to monitor quality control of PBIN team and public insurance and benefits-related material within electronic documentation systems and works collaboratively with PBIN management sharing observations and implementing improvements.
• Provides administrative support to PBIN managers for grant reporting requirements and the collection of data to document the volume of PBIN’s individual and collective work.
• Other duties as assigned.
  
  

Core Whitman-Walker Knowledge, Skills, and Talents Required:

• Ability to work independently with minimal supervision.
• Ability to manage time and effort to meet strategic objectives and complete work.
• Knowledge of principles and processes for providing excellent customer service, both internal and external.
• Knowledge of all applicable WWH policies and procedures.
• Excellent oral and written communication skills.
• Knowledge of healthcare information systems with the ability to adapt to new insurance eligibility, electronic medical records, and population health platforms.
• Ability to maintain records and information in an accurate, timely and confidential manner.
• Ability to adapt to changes in the service delivery model, re-prioritizing as necessary.
• Flexibility to work various shifts, including afternoon and evening shifts as necessary.
• Flexibility to work within the organization's various locations as necessary.
• Commitment to health equity.
  
  

Role Specific- Knowledge, Skills, and Talents Required:

• DC Health Link certification as Certified Application Counselor (CAC) required (may have In Person Assister certification but will be required to transition and maintain CAC certification).
• Successful completion of 4–6-week internal WWH PBIN Training.
• A passion for assisting others and a strong interest in access to care and health reform implementation are required.
• Ability to quickly learn and stay on top of updates to insurance options for commercial and public benefits programs, specifically eligibility criteria, benefits, application procedures, and how to troubleshoot problems as they arise.
• Ability to work on multiple tasks simultaneously and triage a high volume of patients and consumers seeking PBIN assistance.
• Ability to recognize cultural, language, and learning differences and be able to assist individuals in an affirming and culturally and linguistically appropriate manner.
• Ability to grasp complex facts, procedures, and laws. The ability to work quickly, independently, and responsibly.
• Must be a collaborative problem solver, effective communicator, and embrace a diverse team environment.
• Strong computer skills, including knowledge of Microsoft Office tools and the ability to quickly learn new programs, including electronic medical records and insurance-related web programs.
  
  

Education and Experience Required:

• A bachelor’s degree or 4 to 5 years or more of relevant experience in (healthcare, social services, eligibility and enrollment, customer service/reception in a similar field).
• Written and oral fluency in Spanish or Amharic is required.
• Experience working with members of the Lesbian, Gay, Bisexual, Transgender, Gender Expansive, Queer, Asexual, and Intersexed communities preferred.
• Experience working with people living with HIV or issues related to HIV care preferred.
• The position is lateral to PBIN Navigator.
  
  

The above job description is designed to indicate a general sense of the duties and expectations of this position. It is not to be interpreted as a comprehensive inventory of all duties and responsibilities required. As the nature of our business demands change, so too, may the duties and responsibilities of this position. You may be required to perform other duties as requested, directed, or assigned.

Whitman-Walker is an equal employment opportunity employer and does not discriminate against applicants, its employees, or former employees based on race, color, religion, gender, marital status, sexual orientation, national origin, age, disability, veteran status, or gender identity. For accommodation in the application process, please contact Human Resources.