Member Care Navigator

Frontier Direct; Harlingen (TX); In loco; USD 42.000 - 64.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental, and vision insurance

Frontier Membership for you and your (

Voluntary insurance: short-term/long‑/

401(k) plan

Descrizione del lavoro

Frontier Direct in Harlingen, TX is seeking a dedicated Member Care Navigator to guide members through their healthcare journey with empathy and accuracy. You will provide information on benefits, document interactions, and escalate issues as needed.

You’ll manage calls and emails, support scheduling, and use EHR/EMR systems while meeting performance metrics and contributing to quality improvements.

Join a mission-driven team that values patient outcomes and excellent service.

Competenze

• Minimum 3 years of experience in a healthcare setting (e.g., Medical Assistant, CNA, Concierge, Patient Navigator, Case Manager).
• Experience with patient scheduling (medical office, clinic or health system).
• Working knowledge of CPT/ICD-10 codes and healthcare procedures.

Mansioni

• Answer inbound calls and serve as the main contact for member/provider questions.
• Respond to inquiries about claims, referrals, benefit information, plan design, and Direct Pay casework.
• Proactively manage tasks, including outbound calls to members, providers, and insurers.
• Diligently maintain email inboxes and alerts to ensure timely response.
• Meet or exceed performance metrics related to call coverage 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.

Conoscenze

Bilingual Spanish/English

Healthcare experience

Scheduling experience

EHR/EMR proficiency

Call center experience

Medical terminology CPT/ICD-10

Strumenti

EHR/EMR systems

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!

TRANSFORM HEALTHCARE AND CREATE MASSIVE IMPACT

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 escalate 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

• 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.