Essential Job Statements
Provide members with education on effectively utilizing their VCU Health benefits in accordance with their specific policy.
Help members navigate their benefits when confronted with complicated health situations, aligning with the care and treatment recommended by their healthcare provider.
Develop strategies, maintain comprehensive documentation of member interactions, and generate reports for the purpose of tracking progress and facilitating future reviews.
Facilitate team meetings and actively engages in ad hoc meetings when required.
Sustain an interactive relationship with the members and/or their HIPAA authorized representative (POA), by providing ongoing support for their healthcare needs.
Actively engage in quality assessment and process improvement initiatives.
Establish and maintain a collaborative relationship with the care navigation team to review case history and/or claims and engage in discussions regarding the subsequent steps and supportive interventions based on the VCU Health policy.
Represent Center for Team Care at benefit fairs and other team member resource initiatives.
Patient Population: N/A
Employment Qualifications
Education Required: Bachelor’s Degree
Education Preferred: N/A
Licensing/ Certification
Licensure Required: N/A
Licensure Preferred: N/A
Certification Required: N/A
Certification Preferred: N/A
Minimum Qualifications
Years and Type of Required Experience: 3+ years of experience in health benefits education or similar roles, specifically working with patients and family members to understand the benefits available to them.
Other Knowledge, Skills and Abilities Required: Familiarity with HIPAA regulations and the process for claims resolution. A history of assisting clients or members in navigating complex health or insurance situations. Prior work in a collaborative team environment, especially in reviewing plan documents or insurance claims. Ability to build and maintain strong client relationships, especially in sensitive or difficult scenarios. Proven leadership or facilitation skills, especially in conducting team meetings. Experience in outreach or liaison roles, coordinating between clients and external entities like healthcare providers. Strong documentation skills, with experience in maintaining records of client or member interactions. Experience in generating and analyzing reports to track progress and aid future reviews.
Other Knowledge, Skills and Abilities Preferred: Background in case management, social work, process improvement, or similar experience within the healthcare space.
Combination of education and experience may be considered in lieu of a degree.
Working Conditions: N/A
Physical Requirements
Physical Demands: N/A
Work Condition: N/A
Additional Physical Requirements/ Hazards
Physical Requirements: N/A
Hazards: N/A
Mental/Sensory – Emotional
Mental/Sensory: N/A
Emotional: N/A
EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.