Benefits Navigator - Racine

JOB PURPOSE AND REPORTING STRUCTURE : The Patient Benefits Navigator is a key clinic-based role at Racine Community Health Centers. Under the direction of the Benefits Coordinator, this individual is responsible for assisting patients with insurance enrollment, verifying coverage, and facilitating access to various programs. The position plays a critical role in expanding access to healthcare services and addressing social determinants of health (SDOH) by providing personalized support and resource navigation to underserved / vulnerable patients. The coordinator will offer comprehensive benefits guidance to ensure patients can effectively navigate available services and options.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Other duties may be assigned.

Provide consumers with information and guidance to help them understand new health insurance options and identify the most affordable coverage that meets their needs.

Work collaboratively with Racine / Outreach Community Health Centers (OCHC) clinics, community service programs, three OCHC-subcontracted clinics, and community sites serving underserved populations to offer individualized support navigating community benefit programs.

Serve as a liaison between providers and the Benefits team to streamline referrals, improve workflows, and ensure seamless service delivery.

Assist patients with the single, streamlined application process to determine eligibility for Medicaid or the Affordable Insurance Marketplace. Applications may be completed in-office or in the community using a mobile laptop.

Maintain expertise in eligibility and enrollment rules, qualified health plan options, insurance affordability programs, the needs of underserved / vulnerable populations, and privacy / security standards.

Conduct sliding fee scale assessments and determine patient eligibility in accordance with organizational policies and federal guidelines.

Provide information and assistance in a fair, accurate, and impartial manner that is culturally and linguistically appropriate and accessible to individuals with disabilities.

Complete all required federal and state consumer assistance training and maintain compliance.

Coordinate with interpreters to assist patients with limited English proficiency.

Track application statuses, conduct follow-ups to ensure approvals, and address denials, lapses, or gaps in coverage.

Accurately document all patient interactions, eligibility determinations, and outcomes in EPIC, and maintain physical files containing applications and verification documents.

Maintain and routinely update a resource directory of local, state, and federal programs to support patient needs.

Participate actively in team meetings, providing insights to support continuous improvement in insurance and benefits workflows.

Maintain technical competency and stay current on industry changes; perform all data entry accurately in the electronic system.

Attend Outreach and Education meetings through the Milwaukee Enrollment Network.

Develop and maintain positive working relationships with clients, colleagues, and community partners.

Attend all trainings and workshops related to the project and agency expectations.

Ensure compliance with all safety procedures, work rules, and organizational standards, including departmental housekeeping.

Consideration & Statement :

Racine Community Health Centers mandates that all employees be fully vaccinated against MMR (Measles, Mumps, Rubella), Varicella, and Influenza.

Racine Community Health Centers, Inc. is an Equal Opportunity Employer