Certified ACA Enrollment Navigator Lead

General Description:

The Certified Affordable Care Act (ACA) Enrollment Navigator Program at Prism Health North Texas partners with the United Way Metropolitan of Dallas consortium to support consumers in North Texas with Affordable Care Act enrollment. The certified enrollment navigator, a pivotal role in this program, is responsible for educating and assisting individuals, families, and community partners in understanding insurance options available through the Health Insurance Marketplace. They also provide crucial assistance in completing the enrollment application process. The enrollment navigator's role is to assist consumers with application preparation to establish eligibility and enrollment in ACA Marketplace coverage. They also provide outreach and education to raise awareness about the Marketplace, referring consumers to health insurance ombudsman and consumer assistance programs when necessary. The program coverage counties are Collin, Cooke, Dallas, Denton, Ellis, Fannin, Grayson, Henderson, Hunt, Kaufman, Navarro Rockwall, and Tarrant. We are looking for passionate team members to help consumers enroll in the Affordable Care Act to enhance consumers' access to healthcare services

Specific Navigator Lead Responsibilities of the Job:

• Respond to individual Navigator questions and notify the Program Director when further assistance is needed, or an issue should be discussed during a team meeting.
• Serve as the liaison for Navigators, sharing positive and negative interactions and collecting documentation for the monthly report.
• Assist the Program Director with onboarding and training new Navigators.
• Assist the Program Director with new community partner outreach.
• Review Navigator enrollment documents for accuracy before final approval from the Director.
• Complete and pass the online Affordable Care Act Navigator training to become certified and comply with state or federal training, reporting, and monitoring rules.
• Provide in-person and virtual outreach and education campaigns, conduct Marketplace insurance coverage eligibility screenings, provide enrollment services for a Qualified Health Plan via the ACA Marketplace website, and make appropriate referrals for consumers and eligible family members professionally and unbiassed.
• Assist consumers with complex issues related to navigating the Marketplace appeals process and understanding the tax-filing implications of enrolling in a Marketplace plan.
• Provide ongoing documentation to support engagement and enrollment efforts.
• Utilize various mediums (phone, virtual, outreach events, etc.) to provide consumers with technical assistance during open enrollment timeframes determined by federal and state guidelines.
• Assist with uploading application documents, submitting appeals, and other consumer-focused assistance.
• Interview individual consumers to obtain information needed to apply for insurance and potential payment assistance programs.
• Assume and maintain responsibility for enrollment navigator program supplies and equipment and manage all supplies/equipment as directed.
• Other duties as assigned by the program director to meet program deliverables.

Required Knowledge, Skills and Abilities:

• Fundamental knowledge and ability to explain the basics of health insurance, educate consumers about benefits summary, clarify details with explanation of benefits and provide general information about coverage options available through the ACA Marketplace.
• Ability to put clients at ease while asking sensitive and personal questions in order to assess for eligibility and support the patient to apply for Marketplace coverage.
• Relevant experience and ability to work with people of diverse racial, ethnic, and socio-economic backgrounds to educate consumers about marketplace plans, other public coverage options and provide ACA enrolment assistance.
• Strong communication skills (oral and written) and ability to interact professionally with a variety of stakeholders including consumers, families, health professionals, community agencies, and government departments. Experience working with patients, coordinating events, and educating consumer groups.
• Ability to quickly learn new software program to document and organize work duties. Excellent computer skills, including familiarity with Word, Excel, PowerPoint and the ability to browse the Web comfortably, experience with database/electronic health record software a plus.
• Ability to work independently and in a team environment to meet program deliverables.
• Experience working with nonprofit organizations, community groups and/or government programs.
• Experience working in a data-driven environment and a proven track record of achieving program deliverables.
• Strong interest in community health/health equity/access to healthcare coverage for uninsured consumers.

Job Requirements:

• Successfully complete all required federal Navigator trainings, pass the required Navigator certification exam, participate in relevant and assigned webinars, and comply with continuing education and ACA Navigator recertification requirements throughout the program lifecycle within 30 days of employment.
• Conduct consumer outreach and marketing within local communities about health insurance options through the Health Insurance Marketplace and assist consumers to enroll for healthcare coverage.
• Assist consumers to enroll for marketplace coverage during open enrollment, special enrollment periods, and engage consumers in ACA related activities throughout the year.
• Work independently and with team members, travelling throughout the 12 designated counties to provide in-person and virtual ACA consumer group or individual enrollment activities.
• Serve as a resource for consumers seeking to understand the Federally Facilitated Marketplace, health insurance options and provide courteous, professional and confidential assistance to all consumers seeking healthcare coverage access and information.
• Identify and build strategic partnerships with community-based groups and organizations to amplify program efforts.
• Handle sensitive and personal information with an understanding and respect for consumer confidentiality.
• Provide documented consumer engagement, follow-up and data-entry to capture consumer referrals and outcomes.
• Achieve performance targets, working closely with the other Navigators, program supervisor and consortium partners to identify and overcome challenges. 
• Remind potential participants of appointments through reminder postcards and calls and track all consumer contacts.
• Provide weekly, monthly, quarterly, and yearly required grant data to program manager.
• Work a flexible schedule including evening and weekends. 

Education and Experience:

• Some college experience or a minimum of 3+ years relevant consumer navigation, outreach, support, customer service, or relevant health care experience.
• Certified Community Health Worker or Licensed Social Worker preferred 
• Experience in health insurance, educate consumers about benefits summary preferred.
• Experience in consumer outreach and follow-up preferred.
• Ability to interact respectfully with people of different racial, ethnic, and socio-economic background.
• Ability to travel with use of a personal vehicle with current and valid Texas state driver’s license and auto insurance.
• Comfortable speaking before groups and able to actively engage the public in outreach situations.
• Bilingual skills highly preferred.