Insurance Implementation Specialist Jobs in Reston, VA

About Whitman-Walker Health

Whitman-Walker envisions a society where all persons are seen for who they are, treated with dignity and respect, and afforded equal opportunity to health and wellbeing. Through care, advocacy, research, and education, we empower all persons to live healthy, love openly, and achieve equality and inclusion. For over 40 years, we have been meeting the needs of our communities with the endless dedication of our diverse teams.

Job Summary

Whitman-Walker Health (WWH) is seeking a Bilingual Insurance Helpline Navigator. Navigators help WWH patients and DC, MD, VA residents with health insurance and public benefits eligibility, enrollment, and literacy - connecting people to Medicaid, Medicare, Qualified Health Plans on the exchange, subsidies, other insurance opportunities and public benefits. This position is a specialized entry level position to support the PBIN team and facilitate patient and consumer access to insurance coverage and troubleshooting issues. Responsible for the Insurance Helpline, scheduling and connecting patients/clients to PBINs for assistance, insurance verification, triaging issues, and other tasks as assigned. Navigators have been on the front lines of implementation of health reform as certified DC Health Link Assisters and providing critical consumer outreach and enrollment assistance to uninsured and under-insured DC, MD, VA residents.

Core WWH Primary Essential Duties:

• Performs and behaves in accordance with Whitman-Walker’s mission, cultural norms and core values ofdignity, respect, affirmation and humility.

• Maintains a respectful, non-judgmental, and compassionate manner with patients/clients/staff.

• Demonstrates excellent customer service by identifying and exceeding customer requirements.

• Adheres to Whitman-Walker policies and procedures, with special attention given to HIPAA requirements.

• Maintains data integrity through conscientious use of relevant tools and employing a system of checks andbalances.

• Demonstrates organizational skills necessary to multi-task, meet deadlines and re-prioritize as needed.

• Participates in organizational quality and performance improvement activities.

Role Specific Primary Essential Duties:

• Supports the Insurance Helpline by answering the Insurance Helpline, responding to consumer and staff inquiries about eligibility, benefits/coverage, application requirements and renewal procedures as well as needed documentation to get and keep health insurance. In addition, helps to identify any barriers to care and understand what other services they may need at WWH and how PBIN can help them achieve their care goals.

• Navigators are expected to efficiently handle calls on the PBIN (Public Benefits and Insurance Navigation) Insurance Helpline, prioritizing client needs and resolving the clients' concerns. Navigators are expected to exhibit a customer-centric approach in a timely manner. Navigators are expected to maintain a call answer rate and a missed call rate close to the department average.

• Responds promptly to internal insurance verification inquiries, telephone encounters, internal referrals and internal systems to track public insurance coverage assignments.

• Uses internal systems to track public insurance coverage assignments and notifies billing of any Insurance updates to process outstanding claims.

• Works with Insurance Helpline Specialist or Senior Insurance Helpline Specialist to monitor and report call and schedule volume to management and recognizes general trends in type of issues being presented, create interventions, and identify team responsiveness to assist management with ensuring high quality, efficient delivery of services and capacity.

• Serves as a point of contact for questions from PBINs and staff about connecting consumers and staff to PBIN services and information about eligibility for insurance and programs to assist consumers.

• Insurance Helpline Navigator will participate in yearly Part D open enrollment working with legal services to support our client’s medication needs.

• Handles troubleshooting of routine enrollments and eligibility and coverage issues with support from managers, Senior Specialist, or Specialist, when needed.

• Insurance Helpline Navigators will operate as backup PBIN when needed.

• Navigators will manage the tracking of clients' applications in Legal Server and advocate as necessary.

• Supports management and the team in centralizing procedures that assist the team to ensure that public insurance applications and benefits are completed timely and accurately, including obtaining signatures and facilitate the completion of clinical information from medical staff, completing data entry, among other needed tasks.

• Observes trends and other operational issues impacting delivery of efficient service and reporting on them to management and through team meetings.

• Resolves issues impacting patient health billing on insurance claims that were denied claims or require additional information to successfully bill (i.e.: Third Party Liability (TPL), Insurance Pending, Insurance Needed, etc.), as assigned.

• Coordinates and communicates with patient health billing to ensure accurate and timely processing of complex claims and to monitor quality control of PBIN team and public insurance and benefits-related material within electronic documentation systems and works collaboratively with PBIN management sharing observations and on implementing improvements.

• Update client information and upload documents into WWH’s electronic medical record system and online Legal Services database, as needed.

• Provides administrative support to PBIN managers for grant reporting requirements and the collection of data to document the volume of PBIN’s individual and collective work.

• Other duties as assigned.

Budget Responsibilities

None

Management Responsibilities

None

Core WWH Knowledge, Skills, and Talents Required:

• Ability to work independently with good judgment and minimal supervision.

• Ability to manage time and effort to meet strategic objectives.

• Knowledge of principles and processes for providing excellent customer service, both internal and external.

• Knowledge of all applicable WWH policies and procedures.

• Excellent oral and written communication skills.

• Knowledge of healthcare information systems with the ability to adapt to new electronic medical recordand population health platforms.

• Analytical skills necessary for the preparation of accurate, concise, and comprehensive reports.

• Ability to maintain records and information in an accurate, timely and confidential manner.

• Ability to adapt to changes in the service delivery model, re-prioritizing, as necessary.

• Commitment to health equity.

Role Specific- Knowledge, Skills and Talents Required:

• DC Health Link certification as Certified Application Counselor (CAC) required (may have In PersonAssister certification but will be required to transition and maintain CAC certification).

• Successful completion of 4–6-week internal WWH PBIN Training.

• A passion for assisting others and strong interest in access to care and health reform implementationrequired.

• The ability to quickly learn and stay on top of updates to insurance options for commercial and publicbenefits programs, specifically eligibility criteria, benefits, application procedures, and how to troubleshootproblems as they arise.

• The ability to work on multiple tasks simultaneously and triage a high volume of patients and consumersseeking PBIN assistance.

• The ability to converse well in Spanish and to understand written Spanish required. Successfully pass thePeople Services administered language access test.

• The ability to recognize cultural, language, and learning differences and be able to assist individuals in anaffirming and culturally and linguistically appropriate manner.

• The ability to grasp complex facts, procedures, and laws. The ability to work quickly, independently, andresponsibly.

• Must be a collaborative problem solver, effective communicator, and embrace a diverse team environment

• Strong computer skills, including knowledge of Microsoft Office tools and the ability to quickly learn newprograms, including electronic medical record and insurance related web programs.

Education and Experience Required

• Bachelor’s degree or 4 to 5 years or more of relevant experience in (healthcare, social services, eligibilityand enrollment, customer service/reception in similar field)

• Written and oral fluency in Spanish or Amharic required.

• Experience working with members of the Lesbian, Gay, Bisexual, Transgender, Gender Expansive, Queer,Asexual, Intersexed communities preferred.

• Experience working with people living with HIV or issues related to HIV care preferred.

• Position is lateral to PBIN Navigator.

Working Conditions:

Working conditions for this position are normal for an office environment. Individuals may be required to work evenings and / or weekends and organization events.

Physical Demands:

• Lifting: No more than 20 lbs. and infrequently.

• Movement: Standing and sitting for long periods.

• Visual: Long periods on computer.

• Concentration: Extended periods of engagement with computer systems where concentration is key toaccuracy in data entry. Extended periods of engagement with a telephone system to respond to inquirieswhere concentration is key to task performance.

• Communication: Direct and indirect communication. Written and verbal competency

The above job description is designed to indicate a general sense of the duties and expectations of this position. It is not to be interpreted as a comprehensive inventory of all duties and responsibilities required. As the nature of our business demands change, so too, may the duties and responsibilities of this position. You may be required to perform other duties as requested, directed, or assigned.

Whitman-Walker is an equal employment opportunity employer and does not discriminate against applicants, its employees, or former employees based on race, color, religion, gender, marital status, sexual orientation, national origin, age, disability, veteran status, or gender identity. For accommodation in the application process, please contact Human Resources.