JOB TITLE: PATIENT FINANCIAL SERVICES NAVIGATOR
DEPARTMENT: PATIENT FINANCIAL SERVICES
HOURS & SHIFT REQUIREMENTS: Regular full time, 40 hours weekly, Monday thru Friday, 8 – 4:30.
GENERAL SUMMARY
The Patient Financial Services Navigator is a professional who serves as a resource for patients by helping navigate and understand the Medicaid process, ensuring accurate insurance information, and supporting timely reimbursement while providing compassionate and professional service.
This position helps patients understand their benefits, obtain or maintain Medicaid coverage and complete required paperwork. The Navigator works closely with patients, state agencies, and internal departments to reduce delays in coverage and payment.
Overall, the role combines healthcare customer service, insurance expertise, and patient advocacy to help individuals obtain coverage and reduce financial barriers to receiving care.
GIBSON AREA HOSPITAL & HEALTH SERVICES MISSION STATEMENT
To provide personalized, professional healthcare services to the residents of the Communities we serve.
PRINCIPLE DUTIES AND RESPONSIBILITIES
1. Screen patients for Medicaid eligibility and other financial assistance programs.
2. Verify Medicaid eligibility and update insurance information in the billing system.
3. Assist and/or Educate patients with Medicaid applications, benefits, covered services, renewals and eligibility questions.
4. Explain insurance benefits, coverage, copays, and patient financial responsibility.
5. Help patients complete and submit required forms and supporting documentation.
6. Follow up with patients regarding missing information needed for Medicaid processing.
7. Track application status and resolve issues with state Medicaid agencies.
8. Assist uninsured or underinsured patients with charity care or hospital financial assistance applications.
9. Work with physicians, nurses, case managers, social workers, and billing departments to coordinate coverage.
10. Document patient interactions and maintain accurate records in the electronic health record (EHR).
11. Work with state Medicaid agencies and managed care organizations to resolve eligibility or coverage issues.
12. Maintain patient confidentiality and comply with HIPAA regulations.
13. Perform other duties as assigned.
PHYSICAL REQUIREMENTS
1. Works requires the ability to lift and carry boxes weighing between 5 to 25 pounds.
2. Physical strength to perform the following lifting tasks:
a. Floor to Knuckle- 20 pounds
b. 12” to Knuckle- 30 pounds
c. Knuckle to Shoulder- 20 pounds
d. Shoulder to Overhead- 10 pounds
e. Carry 14ft.- 20 pounds
f. Push 25ft.- 10 ft/lbs
g. Pull 10 ft.- 10 ft/lbs
3. Work required ability to stand up for fifteen minutes at a time.
4. Work requires communication abilities necessary to gather and exchange information with all departments, including the ability to use a telephone.
5. Work requires ability to use a computer.
6. Work requires visual acuity necessary to observe and obtain information and use documentation.
7. Auditory acuity to hear patient/family/others for purposes of communication.
REPORTING RELATIONSHIP
Reports to Director of Patient Financial Services.
EDUCATION, KNOWLEDGE AND ABILITIES REQUIRED:
1. High School Diploma, GED, or Equivalent.
2. Minimum of 2 years of experience in medical billing, insurance follow-up or related medical field
3. Familiar with the Legal and Ethical Compliance in charging and billing.
4. Experience with electronic medical records (EMR/EHR) and billing software.
5. Excellent written communication skills.
6. Knowledge of Medicaid eligibility rules and healthcare insurance.
7. Customer service and communication skills.
8. Attention to detail and organizational ability.
9. Problem-solving and advocacy skills.
10. Familiarity with medical terminology, billing, and EHR systems.
11. Ability to handle sensitive financial and personal information confidentially.
12. Ability to explain complex information in an easy-to-understand manner
13. Ability to work independently and as part of a team
COMPENTENCIES
1. Revenue Cycle Knowledge: Understanding of the Revenue Cycle process including claims, payment posting, accounts receivable, denial management, and reimbursement processes.
2. Attention to Detail: Accurately enter demographics, insurance information, adjustments with minimal errors.
3. Analytical / Problem-Solving: Ability to investigate and identify application discrepancies and implement corrective actions.
4. Productivity & Time Management: Prioritizes workload, meets deadlines, and manages high volumes of applications efficiently.
5. Compliance & Confidentiality: Maintains HIPAA compliance and protects patient health information during billing and collections activities.
6. Communication Skills: Communicates professionally with patients, providers, insurance carriers, and coworkers.
7. Technology Proficiency: Experience with practice management systems, EHR/EMR platforms, clearinghouses, and software such as Microsoft Office/Excel.
8. Accountability / Ownership: Takes responsibility for assigned accounts, follows claims through resolution, and escalates issues appropriately.
9. Team Collaboration: Works effectively with providers, front office staff, billing office staff and leadership to improve reimbursement and workflow efficiency.
INFECTION EXPOSURE RISK LEVEL
Category 3 – No Risk – Your job does not involve exposure to blood, body fluids or tissue. You do not perform or help in emergency medical care or first aid as part of your job.
WORKING CONDITIONS
1. Works in a normal office where there are relatively few discomforts due to adverse or hazardous working conditions. There is some exposure to noise and personal space is limited.
2. Will work in an office with co-workers where traffic may be constant, subjecting your work to interruption, which can produce stress and fatigue.
