The Patient Navigator assists patients in accessing and maintaining health insurance coverage through Medicaid and ACA Marketplace programs. This position provides enrollment assistance, coverage verification, application follow-up, and support navigating barriers to care. The Patient Navigator also provides backup lobby assistance, conducts assigned insurance and Sliding Fee Discount Program audits, and collaborates with Registration and other departments to promote accurate documentation, regulatory compliance, and access to healthcare services.

Qualifications

Education:

High school diploma or GED required.

Certifications & Licenses:

Complete applicable Marketplace assister training and authorization before performing regulated activities.
Certified Application Counselor or other authorized application-assister designation, subject to organizational and program approval.

Experience:

One to two years of healthcare registration, patient access, Medicaid eligibility, insurance verification, or benefits assistance experience preferred.

Knowledge, Skills, Abilities:

Working knowledge of North Carolina Medicaid, Medicaid managed care, and ACA Marketplace coverage.
Strong communication, customer service, organizational, follow-up, and independent-work skills.
Ability to assist with online applications and documentation.
Proficiency with electronic health record and insurance verification systems.
Ability to protect confidential information while working in a busy lobby.
Bilingual English/Spanish skills required.

Essential Duties and Responsibilities

Assist patients with Medicaid eligibility verification, applications, renewals, and supporting documentation.
Help patients navigate ACA Marketplace enrollment, identify potential coverage options, and complete applications within authorized training and certification requirements.
Follow up on pending applications, unresolved coverage concerns, and potential gaps in insurance coverage.
Provide backup lobby assistance by greeting patients, directing them to appropriate departments, and identifying those who need enrollment or coverage assistance.
Maintain accurate documentation of patient assistance, application status, follow-up activities, and confirmed coverage changes in approved systems.
Coordinate with Registration and the Sliding Fee Discount Program (SFDP) to resolve coverage concerns and ensure appropriate follow-up.
Conduct weekly audits of selected PSR encounters and Access/Registration applications to identify insurance accuracy, documentation, and eligibility verification issues.
Conduct monthly audits of SFDP applications for completeness, income calculations, assigned discount levels, and effective and expiration dates.
Document audit findings, communicate discrepancies to leadership, coordinate corrective-action follow-up, and identify opportunities for process improvement.
Prepare weekly activity and audit reports, including patient assistance, enrollment activity, audit findings, outstanding corrections, and follow-up needs.
Maintain HIPAA compliance, protect confidential patient information, and follow all applicable organizational policies and procedures.
Perform additional duties as assigned to support organizational goals.

Work Environment & Schedule

Must be able and comfortable working in a variety of settings including, but not limited to clinical environments and office spaces.
Must be able to work nights and weekends as departmental needs arise.

Travel Requirements

Core Competencies

Communication: Demonstrates strong verbal, written, and digital communication skills; able to clearly explain complex information.
Judgment & Decision-Making: Provides thoughtful input into operational and program decisions.
Accountability & Self-Management: Works independently and efficiently, managing multiple responsibilities with minimal supervision.
Teamwork & Collaboration: Builds effective working relationships across teams, departments, and the community.
Problem-Solving & Initiative: Applies critical thinking and initiative to resolve issues and improve service delivery.

Service Delivery Expectations

Demonstrates compassion and respect in all interactions, treating patients, community members, and colleagues with dignity and cultural sensitivity.
Supports the organization’s mission to improve the health of our communities by helping ensure services, information, and resources are accessible to those we serve.
Communicates clearly and effectively with diverse populations while actively listening and responding to community needs.
Maintains confidentiality and handles sensitive information with professionalism and integrity.
Upholds organizational standards, policies, and procedures while promoting high-quality service and continuous improvement.
Demonstrates accountability and stewardship by managing time effectively, prioritizing responsibilities, and meeting deadlines.
Shows awareness of the community served and supports initiatives that improve access to care and health education.
Projects a professional image and collaborates with colleagues, providing guidance or leadership when coordinating activities or supporting team efforts.
Maintains compliance with HIPAA and patient confidentiality requirements.
Follows workplace safety standards and infection control policies when present in clinical environments.

Physical Demands

Prolonged periods of sitting while working at a computer and viewing screens.
Frequent use of hands and fingers for typing, writing, and operating office equipment.
Requires close visual acuity to read screens, prepare and review documents, and assess information.
Occasional standing and walking.
Ability to move throughout office and clinical spaces as needed to perform job duties.
Occasional lifting, carrying, or moving materials, equipment, or supplies weighing up to 25–50 pounds.
Ability to communicate clearly and effectively, both verbally and in writing, in English and Spanish.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Supervisory & Leadership Responsibilities

No direct supervisory responsibilities.
Serves as a knowledgeable resource to staff regarding assigned programs and processes.

Compliance Responsibilities

As part of Kinston Health’s commitment to ethical practices and regulatory compliance, all employees are expected to:

Act in accordance with the Kinston Health’s Employee Handbook, policies and procedures, and all applicable federal and state laws.
Promptly report any known or suspected violations of compliance/safety standards.

These responsibilities are essential to maintaining a culture of integrity and accountability across the organization.

Background Requirements

• Must successfully pass required background checks in accordance with organizational policy.

• Must comply with all organizational credentialing and screening requirements.

Learn more about this Employer on their Career Site

Patient Navigator (Bilingual English/Spanish required)