Patient Advocate II - Patient Engagement (Ambulatory Clinics)

Houston Healthcare•Warner Robins, GA

3d•Remote

About The Position

Patient Advocate 2 manages the investigation, management, regulatory compliance and resolution of complaints and grievances. Collaborates with team members across the system and external resources to support service facilitation requests on behalf of patients, families, leadership, physicians and staff. In compliance with regulatory guidelines, resolves quality of service and quality of care complaints and grievances on behalf of Emory Healthcare. Firmly adheres to federal regulations and Emory Healthcare policies related to the rights and responsibilities of the patient and their representatives, including HIPAA, non-discrimination policies and workplace violence. Patient Advocate 2 serves in advisory role to share the voice of the patient, identify barriers to service, regulatory compliance and support patient experience strategy.

Requirements

Demonstrates expertise in navigating complex patient care situations.
Comprehend and interpret EHC policies impacting safety and customer service.
High degree of interpersonal communication and relationship building skills.
Demonstrated proficiency in computer programs such as customer databases, Microsoft Office and electronic medical record systems
Ability to work independently.
Conflict management.
Highly organized and ability to prioritize multiple tasks and case load.
Local travel may be required.
3-5 years experience of customer service or case management experience
Healthcare experience working with clinical teams and/or patients preferred
Demonstrated conflict management and problem solving skills.
Telecommunication skills and proficiency using multi-line phone and cell phone

Nice To Haves

Bachelor's Degree in healthcare preferred.

Responsibilities

Investigates complaints and grievances and collaborates on issue clarification, chart review, policy and procedure review and interviewing.
Responsible for timely intake, prioritization and delegation of patient complaints, grievances and service facilitation requests.
Complies with all regulatory requirements and EHC policy governing patient complaints and grievances including 7/30 day written responses to patients and documentation in event management system.
Responsible for getting resolution for complex cases in collaboration with leadership and stakeholders.
Leads creation, reviews and timely distribution of reports for Grievance Review Committee, Joint Commission surveys and state regulatory agency visits in compliance with EHC policy.
Adeptly creates and analyzes reports from Risk Management documentation system for trends and improvement opportunities.
Collaborates with Patient Financial Services on billing complaints as needed.
Rounds in clinical areas and provides real time coaching.
Prepares and presents patient advocacy training classes including new employee orientation.
Responds to inquiries from insurance companies regarding quality of care and service concerns raised by members and ensures resolution, follow up and documentation as needed.
Responsible for timely, accurate, and thorough documentation of investigations and resolutions in the event management system.
Demonstrates leadership skills in committees and improvement projects to improve patient experience.
Performs daily rounds in designated areas and partners with clinical teams to address questions, concerns and resolution of requests and performs routine rounds of common areas and reports facility and safety issues needing attention.
Manages complex cases with interdisciplinary teams and responds to cases that are escalated to senior leaders. Successfully engages with multiple levels of leadership to assesses case consequences, makes recommendations based on investigation and advises on timely resolution for complaints and grievances.
Works with risk management, quality department, social services, chaplaincy, physicians, public safety, executive administration and financial services on appropriate written and verbal responses to patient grievances.
Convenes and facilitates multi-disciplinary groups and arranges family meetings as needed for resolution of complaints and grievances.
Works closely with risk managers to identify and investigate matters that have the potential to become a claim or a lawsuit.
Manages the formal grievance process according to CMS rules, Joint Commission and EHC policy.
Serves as a resource to patients, families, and staff for interpretation of Patient Rights and Responsibilities, including HIPAA and Non-discrimination policies.
Advises on content for patient-facing communications to improve patient experience.
Designs and determines appropriate service recovery gestures including decisions relating to monetary compensation and reimbursement.
Assists with recovery and resolution of lost belongings.
Triage incoming concerns and requests – email, phone, in-person.
Delegates and assigns cases to leaders for follow up and resolution.
Works with manager to formulate plan for personal professional development and identify needed resources for training.
Attends meetings, huddles and educational in-services as appropriate.
Actively participates in improvement projects that improve workflows, efficiency, accuracy, and quality of care experience.
Participates in professional activities and organizations to maintain knowledge of current trends, practices, and developments.
Cross-trains with other divisions and flexes time as needed to support Patient Relations coverage for other operating units.
Performs other duties as assigned.