Navigator Presumptive Eligibility Determiner

The Benefit Navigation PE Determiner is responsible for providing Medicaid enrollment services, and organizing programs within the detention center to include data tracking. The Presumptive Eligibility Determiner is responsible for providing culturally appropriate services and serving as a patient advocate, educator, and translator to provide a bridge between the diverse populations they serve and the health care system. The Presumptive Eligibility Determiner will work collaboratively with the Grant County Detention Center and necessary community partners.

The essential functions or duties listed below are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or logical assignment to the position.

• Screen eligible consumers for potential Medicaid eligibility
• Encourage and assist PE applicants with the completion and submission of required forms
• Explain the application process to applicants
• Assure the completeness of information on the application and supporting documentation
• Act as an advocate for the applicant by working with MAD or ISO to resolve eligibility barriers that may arise
• Perform timely follow-up with applicants
• Assist clients with the submission of recertification applications
• Maintain procedures for follow-up and tracking of MAD program applications
• Utilize the online dashboard to track all consumer activity
• Process Emergency Medical Services Authority (EMSA) applications
• HIPAA compliant
• Participate in program meetings
• Track data for programs within the detention center
• Maintains scheduling of programs
• Maintains program binder with all allowed contractors and volunteers
• Implement, maintain, and provide oversight in document workflow.
• Review billing reports for accuracy. Act as liaison and interface with medical, accounting, and/or billing in regard to health coverage issues.
• Perform other job‑related duties as assigned

• High School Diploma or equivalent
• Must have the ability to operate a computer, its software, and general office equipment
• Valid New Mexico State Driver’s License. Must have a good driving record to be insurable for liability purposes.
• Proficient in the use of MS Office and financial management software.
• Must successfully pass the PE/MOSAA Determiner training within sixty (60) days of hire.
• 1 year of Community Health Worker or experience with community, health programs preferred.
• Good organizational skills
• Good communication and interpersonal abilities.
• Experience in navigating Medicaid qualification or insurance eligibility.

• Ability to gather data, compile information, and prepare reports required
• Excellent customer service skills required
• Communication and organizational skills required
• Cultural competence and the ability to work effectively with various constituencies in a diverse community are required.
• Computer skills required
• Knowledge of State, Federal, and HIPAA regulations regarding the release of confidential information required
• Reliable transportation with a valid New Mexico driver's license required
• Public Speaking skills preferred
• Knowledge of community, state, and federal resources/services preferred
• Knowledge of financial accounting, budgeting, and cost control procedures preferred
• Willing to work a flexible schedule