Patient Benefits Navigator Manager

Esperanza Health Centers offers benefits to all its full-time employees:

BCBS Medical PPO Plans| Ameritas Dental |Eye Med Vision| Tuition Reimbursement up to $5,000 per year|10 Paid Holidays and 21 Days of Paid Time Off

Position purpose: The Patient Benefits Manager role will be divided between administrative and benefits navigation duties with a goal of reducing the Esperanza uninsured rate, and growing the patient panel. Administrative duties will focus primarily on overseeing the team of Patient Benefit Navigators, scheduling, distributing and assigning work, monitoring work for progress and quality, and ensuring the work is completed in a timely manner. The Patient Benefits Manager will serve as a resource for the team, providing guidance and troubleshooting problems. Benefits navigation responsibilities include, but are not limited to, assisting patients with enrollment in Medicaid, Medicare, or Marketplace insurance coverage, facilitating patient empanelment, providing patient and staff education on healthcare benefits, and linking patients to medical home resources within Esperanza.

Primary Duties and Responsibilities:

1. Serve as the department manager and schedule, distribute and assign work, monitor work for progress, and ensure the work is completed in a timely manner.

2. Maintain constant and effective communication with the team of Patient Benefits Navigators to provide guidance and manage challenging cases, troubleshoot problems, and answer questions.

3. Lead team member training and performance development.

4. Maintain up to date training on all applicable benefit enrollment plans, including but not limited to, ABE (Medicaid), CAC (Medicare), and Marketplace plans.

5. Initiate team outreach efforts to patients who are uninsured, are due for redetermination, and are aging into Medicare.

6. Provide enrollment assistance (including, but not limited to, completing applications, gathering required documentation, and following up with state and federal enrollment agencies) for uninsured and underinsured patients.

7. Provide patient education on health coverage, assist in benefit navigation, and offer renewal/redetermination assistance for enrolled individuals.

8. Assist in plan selection for HealthChoice Illinois (Medicaid) and Medicare Advantage beneficiaries.

9. Review monthly payer redetermination reports and proactively perform outreach to facilitate redetermination and prevent loss of benefits.

10. Identify and engage with patients who have lost health coverage.

11. Lead department outreach to families with uninsured minors to assist in CHIP/AllKids enrollment.

12. Assist pregnant patients with Medicaid Presumptive Eligibility (MPE) and Moms & Babies enrollment.

13. Collaborate with billing staff to resolve patient billing issues.

14. Lead regular team meetings to review goals, track performance, and solve problems.

15. Facilitate patient empanelment with Esperanza PCPs.

16. Communicate with organization leaders regarding common benefit challenges.

17. Provide support to front-end staff on proper demographic, income information, and insurance capture

18. Work to achieve performance objectives and panel management goals.

19. Cooperates with other personnel to achieve department objectives and maintains good employee relations.

20. Performs other related duties as assigned or requested.

• HS Diploma or GED required 
• Bachelor’s degree or relevant experience preferred
• Two to five years of relevant experience 
• Bilingual, English/Spanish fluency required
• Knowledgeable in MS Excel, Outlook, and Word 
• Knowledge of Medicare, Medicaid, and Marketplace benefit coverage
• Excellent customer service and telephone skills
• Must be well organized and a self-starter
• Must have strong work ethic
• Ability to communicate effectively verbally and in writing
• Ability to interact with staff and patients in a professional manner
• Excellent interpersonal skills