Member Care Navigator

Frontier Direct Care; Harlingen (TX); In loco; USD 42.000 - 56.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental, and vision insurance

Frontier Membership for you and yourim

Voluntary disability and life insuranc

401(k) plan

PTO with up to 5 unplanned days per yr

9 company holidays

Parental leave

Descrizione del lavoro

Frontier in Harlingen, TX is hiring a Member Care Navigator who acts as the trusted main contact for members, guiding them through their healthcare journey with empathy and accuracy. You will provide timely information on benefits, explain CPT/ICD-10 codes, and document interactions using EHR systems.

The full-time role requires bilingual Spanish/English capabilities, healthcare experience, and strong multitasking across multiple systems and workflows while meeting SLAs.

Competenze

• Minimum 3 years in a healthcare setting (e.g., Medical Assistant, CNA, Concierge, Patient Navigator, Case Manager)
• Experience with patient scheduling in a medical office/clinic
• Call center or high-volume office experience preferred
• Experience handling inbound/outbound calls with call metrics
• Working knowledge of CPT/ICD-10 codes and healthcare procedures/regulations
• Proficiency with EHR/EMR or similar ERP systems required
• Ability to multitask across multiple systems and workflows while meeting SLAs

Mansioni

• Answer inbound calls and serve as the main point of contact for member and provider questions
• Respond to inquiries related to claims, appeals, referrals, benefits, plan design, card usage, and Direct Pay casework
• Proactively manage assigned tasks including outbound calls to members, providers, and insurers
• Maintain assigned email inboxes and alerts for timely responses
• Meet or exceed performance metrics related to call coverage, attendance, and case management
• Participate in quality improvement initiatives to enhance processes and member experiences
• Engage in ongoing training and leadership meetings to stay current with updates and system changes

Conoscenze

Bilingual (Spanish & English)

Call center experience

Patient scheduling experience

Medical terminology knowledge

EHR/EMR proficiency

Strumenti

EHR/EMR software

ERP systems

Descrizione del lavoro

At Frontier, we are transforming healthcare. Our patients get access to the care they need quickly and efficiently while experiencing improved health outcomes for the first time in their life. Join us in shaping the future of healthcare!

We build experiences people love by incorporating empathy, care and trust. We challenge the status quo to restore the patient-provider relationship, starting with a team that deeply cares about healthcare and each other.

This is a full time position based at our headquarters in Harlingen, TX.

The Member Care Navigator serves as the trusted main point of contact for our members, guiding them through every step of their healthcare journey with empathy, accuracy, and a sense of purpose. You’ll provide timely and precise information about healthcare benefits, document all interactions, and elevate inquiries or concerns as needed to ensure the highest level of service.

A successful Member Care Navigator is optimistic, resilient, and mission-driven. You approach challenges with grit and empathy, staying calm under pressure and motivated by the purpose behind your work. You find fulfillment in helping others navigate complex systems, always striving to make each interaction a positive and meaningful experience.

What You’ll Be Doing

• Answer inbound calls and serve as the main point of contact for all member and provider questions, regardless of plan design.
• Respond to inquiries related to claims, appeals, referrals, benefit information, plan design, card usage, and Direct Pay casework.
• Proactively manage assigned tasks, which will include making outbound calls to members, providers, insurance companies etc.
• Diligently maintain assigned email inboxes and alerts to ensure timely response and resolution.
• Consistently meet or exceed performance metrics related to call coverage, attendance, and case management.
• Participate in quality improvement initiatives to enhance processes and member experiences.
• Engage in ongoing training and leadership meetings to remain current with all updates, system changes, and group requirements.

Requirements

• Bilingual (Spanish & English) strongly preferred.
• Minimum 3 years of experience in a healthcare setting (including Medical Assistant, CNA, Concierge, Patient Navigator, Case Manager, or other similar roles).
• Experience with patient scheduling (medical office, clinic or health system)
• Call center or high call volume office experience preferred.
• Experience handling both inbound and outbound calls, adhering to specific call metrics
• Working knowledge of Medical terminology
• Working knowledge of CPT/ICD-10 codes, healthcare procedures, and relevant regulations.
• Claims, prior authorizations, medical coding/billing experience preferred
• Demonstrated proficiency with Electronic Health Records (EHR) Electronic Medical Records (EMR) or similar Enterprise Resource Planning (ERP) systems, required.
• Experienced in task-switching and comfortable managing multiple digital tools and workflows simultaneously.
• Demonstrated experience navigating multiple systems and complex workflows while meeting SLAs and other work related metrics.

Benefits

Taking Care of You Now and Your Future

• Medical, dental, and vision insurance
• Frontier Membership for you and your immediate family
• Voluntary insurance: short-term disability, long-term disability, life insurance, and other supplemental insurances
• 401(k) plan

Time Off

• Enjoy our Accrued Paid Time Off (PTO) policy. Within this benefit, we include up to 5 unplanned days off per year
• 9 additional company holidays
• Parental leave policies

At Frontier Direct, we value diversity. We are an equal opportunity employer: we do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.