Eligibility and Quality Navigator- WCMC Wylie

Our mission: Improving the quality of life for all North Texans through medical care, support services and advocacy. Our vision: A healthy community.

HSNT is seeking an Eligibility and Quality Navigator who is passionate about helping others by providing care, education, and resources in a community health setting to patients and families that may have very limited options for their medical needs.

HSNT employees love working for HSNT because we are truly able to make a difference in the lives of the patients whom we serve. Our Eligibility and Quality Navigator will become a part of a tight-knit, interdisciplinary medical team focused on providing high quality care to members of our community. Individuals that are successful in this role tend to be customer-focused and detail oriented, possess a true desire to serve a diverse population of patients, and have experience with benefits and coverage, inclusive of eligibility and enrollment, for programs, such as Medicaid, Medicare, and ACA.

Our Eligibility and Quality Navigator is responsible for performing intake and connecting patients with services and medical care and providing information about services and programs offered by HSNT. In joining HSNT as an Eligibility and Quality Navigator, you’ll be stepping into a strong, established team that is passionate about their work and are focused on learning and developing their skills.

A day in the life of our Eligibility and Quality Navigator may look like this:

• Manages patient payer portal scheduling and monitoring.
• Screens patients for eligibility for programs/healthcare coverage and supports enrollment.
• Gathers pertinent patient, clinical and financial information to optimize the patient’s quality of care.
• Communicates with referral sources, patients, and their family members to educate on HSNT services.
• Processes registration information by performing various duties including insurance verifications, determining the coordination of benefits, and working with various internal sources to understand HSNT’s financial assistance policies and effectively communicate it to patients.
• Responsible for accurately entering all patient information into Electronic Medical Record (EMR) system.
• Coordinates inbound hospital referrals, MOUs, and is the point of contact for communication partner needs.
• Places outbound calls to potential patients.
• Develops and maintains effective working relationships with Providers, Care Managers, Managed Care Organizations, and other pertinent payer/referral sources.
• Always maintains and protects the confidentiality of patient information, enforces patient rights regarding privacy, personal property, and grievances.
• Communicates timely and accurately with referral source and other HSNT departments to ensure coordinated and comprehensive care contributes to the total plan of care.
• Participates in quality initiatives and meetings as needed.
• May perform other duties as assigned by the Business Office Manager and Senior Practice Administrator.

We ask that our Eligibility and Quality Navigator possess the following:

• Education: Associates degree or equivalent experience.
• Minimum 1-year previous full-time experience in a front office role within a medical environment.
• Experienced conversational Spanish/English bilingual (must sign Interpreters Code of Ethics with completion of CBT).
• Experience with benefits and coverage for programs like Medicaid, Medicare, and ACA.
• Knowledge of medical terminology including previous intake experience; scheduling and payment collections.
• Exceptional customer service skills.
• Knowledge of 3rd party reimbursement programs.
• Strong computer skills (including familiarity with electronic health record systems).
• Strongly developed attention to detail.
• Ability to adapt easily to changing environments.
• Ability to multi-task in a busy environment.
• Ability to communicate effectively with all levels of the organization.
• Ability to organize and prioritize.
• Ability to maintain confidentiality.
• Must have proven skills in working independently, self-motivated and goal oriented.
• Ability to work flexible hours, as registration responsibilities may dictate.