PFS - Patient Financial Services Navigator FT

JOB TITLE: PATIENT FINANCIAL SERVICES NAVIGATOR
DEPARTMENT: PATIENT FINANCIAL SERVICES

HOURS & SHIFT REQUIREMENTS: Regular full time, 40 hours weekly, Monday thru Friday, 8 – 4:30.

GENERAL SUMMARY
The Patient Financial Services Navigator is a professional who serves as a resource for patients by helping navigate and understand the Medicaid process, ensuring accurate insurance information, and supporting timely reimbursement while providing compassionate and professional service.
This position helps patients understand their benefits, obtain or maintain Medicaid coverage and complete required paperwork. The Navigator works closely with patients, state agencies, and internal departments to reduce delays in coverage and payment.
Overall, the role combines healthcare customer service, insurance expertise, and patient advocacy to help individuals obtain coverage and reduce financial barriers to receiving care.

GIBSON AREA HOSPITAL & HEALTH SERVICES MISSION STATEMENT
To provide personalized, professional healthcare services to the residents of the Communities we serve.

PRINCIPLE DUTIES AND RESPONSIBILITIES
1. Screen patients for Medicaid eligibility and other financial assistance programs.
2. Verify Medicaid eligibility and update insurance information in the billing system.
3. Assist and/or Educate patients with Medicaid applications, benefits, covered services, renewals and eligibility questions.
4. Explain insurance benefits, coverage, copays, and patient financial responsibility.
5. Help patients complete and submit required forms and supporting documentation.
6. Follow up with patients regarding missing information needed for Medicaid processing.
7. Track application status and resolve issues with state Medicaid agencies.
8. Assist uninsured or underinsured patients with charity care or hospital financial assistance applications.
9. Work with physicians, nurses, case managers, social workers, and billing departments to coordinate coverage.
10. Document patient interactions and maintain accurate records in the electronic health record (EHR).
11. Work with state Medicaid agencies and managed care organizations to resolve eligibility or coverage issues.
12. Maintain patient confidentiality and comply with HIPAA regulations.
13. Perform other duties as assigned.

PHYSICAL REQUIREMENTS
1. Works requires the ability to lift and carry boxes weighing between 5 to 25 pounds.
2. Physical strength to perform the following lifting tasks:
a. Floor to Knuckle- 20 pounds
b. 12” to Knuckle- 30 pounds
c. Knuckle to Shoulder- 20 pounds
d. Shoulder to Overhead- 10 pounds
e. Carry 14ft.- 20 pounds
f. Push 25ft.- 10 ft/lbs
g. Pull 10 ft.- 10 ft/lbs
3. Work required ability to stand up for fifteen minutes at a time.
4. Work requires communication abilities necessary to gather and exchange information with all departments, including the ability to use a telephone.
5. Work requires ability to use a computer.
6. Work requires visual acuity necessary to observe and obtain information and use documentation.
7. Auditory acuity to hear patient/family/others for purposes of communication.

REPORTING RELATIONSHIP
Reports to Director of Patient Financial Services.