Patient Access Navigator

About the role

The Patient Access Navigator play a key role in ensuring patients with bleeding disorders have seamless access to care, treatment, and financial resources. This position proactively supports patients by establishing, verifying, and maintaining insurance eligibility, guiding them through the financial aspects of care, and connecting them with available assistance programs. Working collaboratively with clinical staff, pharmacy, billing teams, and external payers, the Specialist helps patients and families understand coverage, benefits, and billing, and resolves eligibility and billing concerns with compassion and efficiency. This role also develops knowledge of the local community’s resources and culture to better understand patient needs, enhance the overall patient experience, and positively impact health outcomes.

Key Responsibilities

Patient Advocacy & Navigation

·         Serve as a trusted resource and primary point of contact for patients and families navigating insurance, billing, medication access, and financial assistance.

·         Build meaningful relationships with patients by providing compassionate guidance and helping reduce financial and administrative barriers to care.

·         Educate patients and caregivers on insurance benefits, coverage options, cost-sharing responsibilities, and available financial assistance programs.

·         Assist patients with enrollment in Medicaid, Medicare, ACA Marketplace plans, manufacturer assistance programs, and other eligible coverage options.

·         Connect patients with bleeding disorder–specific resources, including specialty pharmacy services, factor product coverage, infusion services, and ancillary support.

·         Maintain expert knowledge of hemophilia financial assistance resources, including manufacturer co-pay assistance, foundation grants, and patient assistance programs.

Insurance & Financial Access

·         Serve as the primary point of contact for patients and families with billing and insurance-related questions.

·         Navigate insurance verification and benefits investigations, clearly explaining coverage options, prior authorization requirements, co-pays, deductibles, and anticipated out-of-pocket costs to help patients understand and overcome financial barriers to care.

·         Identify referral, authorization, and payer requirements to ensure timely access to specialty care, pharmacy, and infusion services.

·         Proactively identify and resolve insurance coverage issues to minimize treatment delays and interruptions.

·         Maintain accurate patient demographic and insurance information across the electronic health record (EHR), billing, and pharmacy systems.

·         Stay current on payer guidelines, insurance policies, and regulatory changes that impact patient access and reimbursement.

Revenue Cycle & Cross-Functional Collaboration

·         Partner with the pharmacy team to stratify patients at risk and proactively identify those needing access intervention.

·         Collaborate closely with clinical providers, pharmacy staff, social workers, and administrative teams to resolve complex coverage and reimbursement challenges.

·         Support revenue cycle by helping prevent claim denials, coverage lapses, and interruptions in treatment or pharmacy services.

·         Promote efficient cross-departmental communication to ensure seamless coordination of care and financial services.

Program Administration & Compliance

·         Support patients in accessing financial assistance programs, including manufacturer assistance, Medicaid, and other federal, state, and community resources that help reduce barriers to care.

·         Maintain accurate and timely documentation of insurance eligibility, patient communications, financial assistance activities, and care coordination in accordance with organizational standards.

·         Assist with quality improvement activities, audits, and reporting by ensuring complete, accurate documentation of patient access and financial assistance services.

·         Maintain compliance with HIPAA, payer requirements, organizational policies, and all applicable federal and state regulations while protecting patient privacy and confidentiality.

·         Support participation in federal and state programs such as 340B, Medicaid, and other assistance initiatives as applicable

Qualifications

·         Preferred: Bachelor's degree in health sciences, human services, social work, psychology, public health, or healthcare administration

·         Required: Associate's degree in health sciences, human services, social work, psychology, public health, or healthcare administration

·         At least 5 years of experience working in a healthcare setting, preferably as a patient navigator, patient access coordinator, revenue cycle specialist, or patient health services specialist.

·         Knowledge of community resources, public benefits, and financial assistance programs, with the ability to connect patients to services that reduce barriers to care and improve access to treatment.

·         Strong communication, collaboration, and problem-solving skills.

·         Ability to conduct insurance and benefit investigations.

·         Skilled at translating complex insurance terminology into easy-to-understand language.

·         Cultural competence and the ability to work with diverse populations.

·         Experience in healthcare customer service handling sensitive conversations with empathy

·         Strong working knowledge of electronic health record (EHR) systems.

PROFESSIONAL EXPECTATIONS:

·         Conduct oneself professionally and with respect for patients, families, colleagues, and external partners.

·         Follow WACBD policies, procedures, confidentiality requirements, and compliance standards.

·         Maintain a patient-centered approach and support a collaborative, service-oriented work environment.

·         Continue building knowledge of bleeding disorders, patient access, insurance, and financial assistance resources.