Medicare / Medicaid Benefit Navigator

General Summary:

The Medicare/Medicaid Benefit Navigator is an advocate for our sisters, ensuring they receive appropriate medical care and benefits. This role involves coordinating enrollment in government programs, liaising with Social Security Administration, and assisting with the processing and payment of medical bills.

Essential Duties and Responsibilities:

Advocate for the sisters with medical providers and government agencies to secure appropriate benefits.

• Determine eligibility, apply, track deadlines, make changes, renew, and ensure continuity of coverage with Medicare A, B, and D, Medicaid, and other government benefits.
• Facilitate communications with commercial insurance companies.

Maintain a high level of expertise on relevant government benefit programs.

• Research annual changes, non-covered services and of government benefits.
• Generate reports for department manager.

Research, verify and approve payment of all medical bills incurred by sisters.

• Respond to the sister’s concerns and resolve billing and payment issues.
• Use Avid, SSND bill pay system.

Cooperate with internal teams to ensure comprehensive care and support for the sisters and maintain good employee relations.

Maintain accurate records and documentation consistently to ensure accuracy, data entry integrity, and generate reports when necessary. This includes using an organized system for storing and retrieving information, as well as updating records to catch errors or discrepancies.

Collaborate with SSND Wellness Department, Community Coordinators and others to assess the sister’s needs for appropriate level of care (IL, AL, Skilled) and housing. When necessary:

• Facilitate options counseling with Aging and Disability Resource Center (ADRC)
• Family Care (FC) Community Care
• PACE Community Care
• Keep up with all policies and procedures

Attend relevant training, meetings, and manage other duties as assigned.

Qualifications:

Requires experience working in healthcare advocacy, medical billing, social work, or related field, including use of the skills listed below or aptitude to learn.

Knowledge, Skills and Abilities:

• Requires knowledge and ability to navigate Medicare, Medicaid, and Social Security
• Strong administrative, organizational, problem-solving skills with a high level of detail
• Excellent communication and interpersonal skills, with compassion and patience
• Ability to maintain a high level of confidentiality
• Must be able to plan, implement and set/rearrange priorities and work independently with minimal direct supervision and as a team member
• Proficiency in Microsoft Office (Outlook, Word, Excel, and PowerPoint) and database management
• Commitment to the mission and values of the organization