Customer Care Advocate

Aston Carter•Santa Clarita, CA

4d•$28 - $28•Onsite

About The Position

The Customer Care Advocate – Reimbursement Specialist supports patients as they navigate complex insurance authorization processes for innovative medical technologies. This role combines prior authorization expertise, denial management, and consultative sales to drive successful patient outcomes through insurance approvals, appeals, or alternative funding solutions. You will manage complex reimbursement cases in a high-touch, collaborative environment and help influence patient decisions when insurance coverage is limited or denied.

Requirements

Demonstrated experience with insurance denials and appeals, including preparing and submitting appeal documentation.
Proficiency in prior authorization processes and medical insurance claims handling.
Ability to review and interpret medical documentation and medical records for reimbursement purposes.
Coding fluency and familiarity with medical coding practices, including ICD-10, to support accurate claim and appeal submissions.
Strong customer service skills, with the ability to provide high-touch support in a patient-focused environment.
Experience in denial management and full payer determination to identify coverage and funding options.
Proficiency with Microsoft Excel and Microsoft 365 for tracking cases, analyzing data, and reporting.
Comfort using CRM systems and call center software to manage accounts and document interactions.
Effective persuasion and negotiation skills to overturn payer denials and secure approvals.
Professional persistence in following up on complex cases and driving them to resolution.
Ability to multitask, manage priorities, and maintain accuracy in a dynamic, fast-paced, collaborative environment.
Commitment to high levels of client satisfaction and adherence to company policies and internal controls.
Minimum 2 years’ experience in medical authorization involving medical record review.
Bachelor’s degree preferred or equivalent relevant experience.
Ability to thrive in a commission-based role and work toward defined performance and sales objectives.

Nice To Haves

Proficiency in medical terminology and ICD-10 coding to support accurate claims and appeals.
Experience in pharmaceutical, biotech, or medical device industries, providing context for product-specific reimbursement challenges.
Medical coding certification preferred but not required.
Hands-on experience with CRM systems, call center software, and Microsoft 365 for efficient communication and case management.
Demonstrated success in achieving sales objectives in a commission-based environment.
Dynamic, results-oriented mindset with the ability to adapt to process improvements and changing workflows.
Strong communication skills, both written and verbal, with the ability to explain complex insurance and reimbursement concepts clearly.
Willingness to complete all required training and maintain up-to-date knowledge of insurance processes, payer requirements, and internal procedures.
Ability to collaborate effectively within an interactive team and contribute to a supportive, results-oriented culture.

Responsibilities

Guide patients through complex insurance authorization and reimbursement processes for medical technologies.
Manage prior authorization requests, including gathering and reviewing medical documentation and submitting complete, accurate cases to payers.
Handle insurance denials and appeals by reviewing payer decisions, identifying issues, and preparing effective appeal submissions.
Perform full payer determination to identify coverage options, alternative funding sources, or other reimbursement pathways.
Review medical records and documentation to ensure accuracy, completeness, and appropriate coding for claims and appeals.
Collaborate closely with internal teams, including inside sales, VA support, and field teams, to resolve complex reimbursement cases and support patient access to care.
Provide high-touch customer care and technical support to patients, healthcare providers, and other stakeholders, maintaining a professional and empathetic approach.
Use consultative sales skills to influence patient decisions when coverage is limited or denied, presenting alternative options and funding solutions.
Utilize CRM systems, call center software, and Microsoft 365 tools to manage accounts, track cases, and document all interactions and outcomes.
Follow up persistently and professionally with payers, providers, and patients to ensure timely resolution of cases and appeals.
Maintain a strong focus on client satisfaction by delivering accurate information, timely updates, and consistent communication.
Contribute to process improvements by sharing feedback, embracing new procedures, and adapting to changes in workflows and payer requirements.
Meet performance and commission-based sales targets related to approvals, reimbursement outcomes, and patient conversions.
Ensure compliance with company policies, internal controls, and applicable regulations in all reimbursement and patient support activities.
Participate in and complete all required training to stay current on insurance processes, coding practices, and product-specific reimbursement guidelines.