Patient Services Navigator
Job Details
Family Health/La Clinica-Mauston - Mauston, WI

The Patient Services Navigator position plays a vital role in providing an exceptional patient experience as well as in securing financial benefits for both the patient and FHLC alike. This position is responsible for patient financial screening, insurance verification, enrolling patients in Marketplace as applicable, securing prior authorizations, tracking sliding fee scale patient screening, processing patient applications and track to completion, providing accurate patient expense estimates, financial counseling, pre-service collections, provider enrollment, and patient community benefit enrollment. The Patient Services Navigator acts as a liaison between patients and internal/ external partners to foster open, professional, timely, courteous, and accurate communication. 

  • Connects with patients via in person and/ or by telephone prior to their scheduled services to complete pre-registration, insurance coverage verification, sliding fee scale application, provide fee estimates, discuss resolution of financial obligations (including prior balances), collect any payments upfront, to financially secure patient account.
  • Receives patient referrals from FHLC’s staff and interfaces regularly with medical and dental providers and support staff to provide patient financial assistance.
  • Assist patients with navigating social services programs such as housing resources, food programs, legal services, transportation, etc., by helping them connect with community-based providers as applicable.
  • Maintains CAC certification to enroll patients in Marketplace as applicable and assist with and Marketplace enrollment changes.
  • Communicate with clinical staff and scheduling to notify of insurance authorization issues/ delays prior to receiving services and reschedule/ cancel if services not authorized; maintain authorization on file as needed going forward for additional services.
  • Administers FHLC’s sliding fee discount program by obtaining necessary patient data and documentation to accurately calculate level for FHLC’s patients.
  • Follows up on patient applications to ensure they are completed timely and accurately.
  • Maintains strong working relationship with county resources and other organizations that review FHLC patient applications for assistance.
  • Initiate appropriate forms for workers comp, disability, etc. as applicable and pass on the appropriate clinical providers to complete to ensure patients can receive their benefits in a timely manner.
  • Ability to analyze and interpret information included in but not limited to sliding fee support application materials, IRS materials, credit reports, payer regulations, payer contracts etc.
  • Handles all patient/family contact in a courteous, professional manner and consistently interacts with sensitivity to patients/their families and is responsive to individual needs.
  • Ability to work collaboratively in a team-based approach with clinical and non-clinical staff, patients and patient’s families.
  • Provides an active voice in team meetings for the purpose of improving services to patients and maximizing patient benefits.
  • Demonstrates ability to interact professionally in a variety of patient situations and adjust accordingly depending on the situation presented at time of service.
  • Must adhere to FHLC policies and procedures.
  • Regular and Reliable Attendance.
  • Performs other duties as assigned.

Family Health La Clinica is proud to be an Equal Opportunity Affirmative Action employer.

To perform this job successfully, the individual must be able to perform each essential duty satisfactorily. This position requires the individual to work independently, as well as in a group setting; Must be able to work under pressure and deal with stressful situations; is analytical and has excellent critical thinking and problem-solving skills; must always maintain patient confidentiality; must be able to establish and maintain effective working relationships with patients, employees, other departments, and external partners.

High School Diploma or equivalent required. Prior experience working in health care setting with knowledge of financial clearance including insurance verification, prior authorization, denials prevention and securing patient accounts. Experience with marketplace enrollment (CAC certification) preferred. Keyboarding and computer skills, as well as familiarity with MS Office applications and Epic desired. Excellent customer service skills required. Understanding and working familiarity with rules and regulations of Federal, State and County programs and payer requirements, particularly in FQHC programs. Must be a Certified Application Counselor (CAC) or complete CAC certification within one year of hire.

Family Health La Clinica(FHLC) requires employees to be vaccinated against COVID-19, or hold a legally recognized exemption as a condition of employment.  Where permitted by law, candidates who are offered a position will be asked about their vaccination status, which must meet minimum business requirements. All religious, medical, or other legally recognized exemptions regarding vaccination status will be considered.

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