Insurance Navigator/Medicaid Redetermination

Job Description

Job Description

POSITION SUMMARY:

The Insurance Navigator / Medicaid Redetermination Specialist plays a critical role in ensuring continuity of care for patients served by Family Health Center by providing comprehensive insurance navigation, eligibility assistance, and Medicaid redetermination support. This position serves as a trusted resource for patients and families, helping them understand and maintain health coverage while reducing coverage gaps that could disrupt access to care. The Navigator works collaboratively with clinical, financial, and community partners to support patients through Medicaid redetermination, Marketplace enrollment, and other public insurance programs, with a strong emphasis on health equity, cultural humility, and patient advocacy.

They collaborate with financial counselors, community health workers, and customer experience technicians to coordinate patient enrollment in Medicaid or Marketplace coverage. They assist in gathering required documentation for initial enrollment and redetermination to help ensure patients maintain adequate coverage and access to the full range of services offered at Family Health Center. They also monitor and evaluate available options to support and optimize each patient’s oral health outcomes. These individuals will serve as gatekeepers to our various communities in the Kalamazoo service area and will support various outreach initiatives with local churches, community and civic organizations, housing complexes, school systems, and other organizations where our patient population may frequent.

DUTIES AND RESPONSIBILITIES:

Medicaid Redetermination and Support

• Serve as the primary point of contact for patients undergoing Medicaid redetermination, ensuring timely completion and submission of renewal applications.
• Proactively identify patients at risk of losing Medicaid coverage and conduct outreach via phone, mail, text, or in-person engagement.
• Assist patients with completing Medicaid renewal forms, providing required documentation, and navigating state eligibility systems.
• Educate patients on renewal timelines, eligibility requirements, and potential outcomes of redetermination.
• Track renewal status and follow up to prevent lapses in coverage.

Insurance Navigation & Enrollment

• Provide enrollment assistance for Medicaid, CHIP, and Affordable Care Act (ACA) Marketplace plans when Medicaid eligibility changes.
• Support transitions between coverage types, ensuring patients understand plan benefits, costs, and provider networks.
• Assist uninsured or underinsured patients in identifying appropriate coverage options and financial assistance programs.
• Maintain certification as a Certified Application Counselor (CAC) or equivalent, as required.

Patient Education & Advocacy

• Deliver clear, culturally responsive education on insurance benefits, patient rights, and responsibilities.
• Advocate on behalf of patients with state Medicaid offices, Managed Care Organizations (MCOs), and insurance carriers when appropriate.
• Support patients facing language, literacy, or technological barriers to enrollment and redetermination.
• Collaboration & Care Team Integration
• Partner with clinical staff, care coordinators, case managers, and billing teams to align insurance coverage with care delivery.
• Participate in interdisciplinary team meetings to identify patients with coverage-related care barriers.
• Coordinate with community-based organizations and state agencies to support patient access to coverage.

Data Tracking, Compliance & Reporting

• Accurately document patient interactions, applications, and outcomes in the electronic health record (EHR) and eligibility systems.
• Track key performance indicators related to Medicaid retention, coverage continuity, and successful renewals.
• Ensure compliance with HRSA, CMS, and state Medicaid requirements, including privacy and confidentiality standards.
• Support audits, grant reporting, and quality improvement initiatives related to insurance coverage and access to care.
• Other duties as assigned.

CORE COMPETENCIES:

Collaborative

• Patient-centered service excellence
• Attention to detail and follow-through
• Cultural humility and trauma-informed care
• Collaboration and teamwork
• Data accuracy and compliance
• Community engagement and outreach
• Displays willingness to make decisions, resolve conflict and collaborate on work assignments in a timely manner
• Adapts to change, takes responsibility for own actions to advance team goals
• Speaks and writes clearly and persuasively in formal and informal presentations
• Actively participates in meetings and uses listening skills to keep an open mind
• Solicits input from appropriate stakeholders, explains reasoning for decisions and uses strong interpersonal skills to communicate and influence others
• Gives recognition to others for results

Solid Character

• Balances team and individual responsibilities while assessing own strengths and weaknesses
• Exhibits objectivity and openness to others’ views
• Welcomes feedback, builds positive team spirit, supports all team members
• Develops alternative solutions, supports and share expertise with other team members while building positive morale
• Demonstrates knowledge of company policies and treats people with respect
• Works ethically and with integrity, upholds organizational values
• Keeps commitments, shows respect and sensitivity for cultural differences
• Educates others on the value of diversity, promotes a positive work environment where all feel free to contribute

Organizational Support

• Completes administrative task correctly and on time, and develops strategies to achieve organizational goals and values
• Supports affirmative action and respect diversity, understands organization’s strengths and weaknesses, analyzes market and competition, and identifies external threats and opportunities while adapting strategy to changing conditions
• Prioritizes and plans work activities while understanding business implications of decisions
• Demonstrates accuracy and thoroughness within approved budget and displays original thinking and creativity
• Displays knowledge of market and competition that aligns with strategic goals
• Meets challenges with resourcefulness, generates suggestions for improving work, develops innovative approaches and ideas

Leadership

• Displays passion and optimism while exhibiting confidence in self and others
• Inspires respect and trust while motivating others to perform well and influencing actions and opinions of others
• Coordinates projects, develops workable implementation plans, includes staff in planning, decision-making, and process improvement

• Communicates and completes changes and progress of projects on time and on budget while managing project team activities to overcome resistance
• Makes self-available to staff, provides regular performance feedback
• Develops individual team member skills and encourages growth

Safety and Security

• Promotes safety precautions and security measures to ensure the safety of both staff and patients
• Adheres to data security guidelines, including appropriate use of EMR systems and IT resources

TYPICAL WORKING CONDITIONS:

• Work is performed both in the community and at one of the health center site locations. Contact with patients and staff.
• Requires at times, working in fast-paced clinical setting, in emergency situations or during irregular hours.

TYPICAL PHYSICAL DEMANDS:

• While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel and talk or listen.
• The employee is frequently required to stand and walk. The employee is occasionally required to sit; reach with hands and arms and stoop and kneel.
• The employee must occasionally lift and/or move up to 50 pounds.
• Specific vision abilities required by this job include close vision, color vision and ability to adjust focus.

QUALIFICATIONS:

• Minimum of 1 – 2 years of experience in community mobilization, outreach, insurance navigation, Medicaid eligibility, patient access or social services preferred.
• Strong interpersonal, communication and organizational skills
• Abilit to work effectively with diverse populations and demonstrate cultural humility
• Viewed as a trusted member of the community
• Proficiency with electronic health records and state eligibility systems preferred.
• Bilingual or multilingual skills are strongly preferred
• Certification as a Certified Application Counselor (CAC) or willingness to obtain within a specified timeframe preferred.
• Experience working in a federally qualified health center, social services, or safety-net environment.

EDUCATION/EXPERIENCE/CERTIFICATIONS/LICENSES:

• Demonstrates customer focused interpersonal skills to interact in an effective manner with practitioners, interdisciplinary health care team, community agencies, patients/families with diverse opinions, values as well as religious and cultural beliefs.
• Demonstrates excellent written, verbal/listening skills.
• Demonstrates positive relationship building skills and critical analysis skills.
• Demonstrates ability to work autonomously and be accountable for practice.
• Demonstrates ability to influence and negotiate individual and group decisions.
• Demonstrates ability to function in a fluid, dynamic, changing environment.
• Must have reliable transportation and valid driver's license to travel to office locations or other locations as assigned.

Family Health Center has the right to modify the duties and functions of the job description based on the needs of the organization.