Patient Advocate

Job description

Job Title: Patient Advocate

Reports to: Director Member Services

FLSA Status: Non-Exempt

Aid members, patients and providers with balance bills, appeals and a variety of questions by phone, fax, email and US mail, working independently within the scope of your duties. Coordinate the handling of numerous daily, time-sensitive functions required to maintain an efficient workflow and direct all matters to a proper resolution.

Essential Job Duties:

• Maintain HIPAA guidelines to ensure the confidentiality of all calls and documents
• Run and disburse daily welcome letters to introduce the patient AMPS advocacy team
• Conduct daily welcome calls to members and patients
• Review and verify Balance Bills using provider billing statements and the Explanation of Benefits
• Prepare and file correspondence regarding challenges to the Plan's reimbursement
• Assist and support members with questions regarding the FCBA dispute process
• Upload incoming emails, faxes and mail into the system for proper handling
• Respond to incoming correspondence received via email, fax, mail and phone within 24-48 hours
• Maintain contact with facilities, professionals, EOB's and debt collectors to assist with the resolution of open advocacy matters
• Provide exceptional customer service for incoming calls throughout the shift
• Accurate and complete documentation of all daily interactions
• Complete a minimum of 40-50 interactions per shift
• Work independently and effectively collaborate with the team
• Act as liaison with TPA partners, employer groups, and brokers as needed to assist and resolve open advocacy matters
• Propose process improvements to enhance member satisfaction
• Escalate advocacy or other complaints per written guidelines
• Update all members / patients with an open advocacy matter every 30 - 45 days
• Other duties as assigned

Skills/Abilities:

• Exceptional customer service skills
• Strong written and verbal communication
• Strong problem-solving skills
• High attention to detail
• Active listening skills
• Organizational skills
• Ability to type 50+ WPM

Education/Experience:

• Minimum 2 years of experience in the Healthcare Industry with patient advocacy, customer service and claims experience
• Associates degree or vocational / technical school in healthcare
• Must have experience in handling multi-line telecommunication systems and electronic documentation software
• Preferred Medical Billing and Medical Coding experience
• Bilingual a plus

Physical Requirements:

• Indoor office environment with moderate noise
• Intermittent physical effort may include lifting to 25 lbs., walking, stopping, kneeling, crouching or crawling may be required
• Frequent sitting, use of a keyboard, reaching with hands and arms, talking and hearing approximately 70% of the time; 30% or less time is spent standing
• Normal vision abilities required including close vision and ability to adjust focus

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