About the Position
The Health Exchange Navigator’s job is to provide individuals and families with the information necessary to determine which health insurance option best fits their needs and then help them enroll in their plan of choice.
Dependent on Experience
Reports to the Director of Outreach and Eligibility
Duties & Responsibilities
The Affordable Care Act created the Navigator grant program and listed the duties Navigators must perform. The Exchange Final Rule, published on March 27, 2012 interprets those duties to include:
- Maintains expertise in eligibility, enrollment, and program specifications
- Conducts public education activities to raise awareness about the marketplace
- Provides information and services in a fair, accurate, and impartial manner; including information that acknowledges other health programs such as Medicaid and CHIP
- Facilitates selection of a QHP
- Provides referrals for enrollees with questions, complaints, or grievances about their health plan, coverage, or a determination under such health plan or coverage to any applicable office of health insurance consumer assistance or health insurance ombudsman or any other appropriate state agency or agencies
- Provides information in a culturally and linguistically appropriate manner, including to persons with limited English proficiency
- Ensures accessibility and usability of Navigator tools and functions for persons with disabilities.
- Accomplishes additional tasks as appropriate
Experience & Qualifications
Education & Experience
- Bachelor’s degree in related field-may be substituted with 4+ years of proven experience in social work or community outreach
- Must be able to achieve and maintain Health Exchange Navigator Certification
- Must have valid driver’s license and reliable transportation for commuting to community events.
- Bilingual (Spanish) preferred
- 1+ years’ customer service experience
- Outreach and advocacy experience preferred
- Health insurance experience preferred
- Must possess a thorough knowledge of modern office practices, procedures, and equipment, including computers, copiers, and other standard office equipment
- Ability to work independently, organize, monitor, and adjust work as necessary to ensure accuracy and timeliness
- Demonstrated ability to identify and solve problems
- Must have adequate training on the Exchange, Medicaid and other public programs and the private insurance market in the state
- Ability to strongly embrace and personify the mission and values of GraceMed with socio-economic and cultural sensitivity in mind
- Must be able to interact with staff at all levels, other government officials, governing boards, private agencies, auditors, and contractors
- Must be free from conflicts of interest, including payments and incentives from insurers or industry.
- Must be trusted by the community to provide appropriate, clear and correct information
- Must be able to explain eligibility, benefits, cost-sharing, and appeals processes to consumers
- Must be able to provide information to individuals and families in a way that can be understood, in a culturally sensitive manner, for those with low-proficiency English, and people with disabilities who have special communication needs
- Must be able to effectively serve low-income, disadvantaged, and hard-to-reach populations
- Must be able to help people understand how premium tax credits work, and their potential financial impact
- Able to meet people with ease; ability to write and edit effectively; ability to communicate the written and spoken word with tact, diplomacy, and/or authority when necessary
Work Environment & Schedule
Medical office setting. Ability to sit and/or stand for long periods of time. Bending, stooping, and lifting (up to 50lbs.) may be required. Interaction with physicians, patients and other office personnel. May involve contact with angry, upset or ill persons. May involve potential exposure to blood and body fluids and other hazardous substances. Must have visual acuity and manual dexterity to interface with computer. Must have auditory acuity to handle phone calls. Travel to various outreach locations required.
Monday through Friday, 8:00 am to 5:00 pm. May require work outside of usual business hours; including evenings or weekends, to handle patient service issues and attend meetings and/or community events.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria considered necessary to successfully perform the job.
As an employee of GraceMed Health Clinic, Inc., you are bound by principles of medical ethics. You have both a legal and moral obligation to protect the privacy of our patients. In the course of your work, you will have access to confidential information regarding patients, and/or the practices’ confidential business. It is essential that you refrain from any discussions regarding personal information about a patient, a patient’s condition, a patient’s finances, proprietary company information, and/or the practices’ confidential business with any third person. This includes, but is not limited to, other employees, your spouse, family or friends.
Confidentiality is so important that any breach of this policy will be considered grounds for termination. Review and signature of the Agreement is a condition of employment. Successful skills testing, drug screening, and a background check are required for employment.