Patient Advocate II, Sutter SeniorCare PACE

Sutter Health•Sacramento, CA

2d•$31 - $39•Hybrid

About The Position

The Patient Advocate is responsible for assisting participants and their families/ caretaker(s) in the annual redetermination process for Medicaid which includes the process of obtaining documentation, providing participants with resources and assisting in necessary paperwork/documentation of all necessary forms. Provides financial counseling to patients and their families. Assists with insurance verification and eligibility, assessment of patient financial requirements and insurance policies. Gains confidence and cooperation from the patient, their family/support group, and other healthcare providers through competent job performance, attentive monitoring and care, and effective communication. Adheres to all local/state/federal regulations, codes, policies and procedures to ensure privacy and safety while delivering optimal patient care. Collaborates with ancillary departments. Proactively identifies participants coming up for Medi-Cal redetermination and Medicare eligibility. Understands and can communicate effectively procedures for Share of Cost, Long Term Medicaid and Spousal Impoverishment. Educate and assist participants with the completion of all necessary forms, and ensure appropriate signatures are obtained. Conduct visits in the center and to participants’ homes to complete forms. Assist with obtaining all documentation required for eligibility determination or redetermination. Complete and file applications by initiating and maintaining proper follow-ups with participants, center staff, and government agencies to ensure timely processing and completion of all mandated applications and accompanying documentation. Ensures compliance with DHCS and CMS policies and procedures and maintains a strong working relationship with agencies. Completes disenrollment paperwork, with participants, as necessary. Processes eligibility, enrollment and disenrollment to government agencies and within the electronic medical record and documents activities and transactions. Verifies eligibility and reconciles to census. This position is a hybrid position, allowed to work some days from home and/or the field in participant's homes and at least four days in the office on-site. This is open to California residents only.

Requirements

HS Diploma or equivalent education/experience
California Drivers License
Proof of valid auto insurance
Knowledge of patient governmental insurance or other third party coverage
Knowledge of insurance and medical terminology
Ability to interpret a variety of data and instructions, furnished in written, oral, diagram, or schedule form
Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people
Well-developed time management and organizational skills, including the ability to prioritize assignments and work within standardized policies and procedures to achieve objectives and meet deadlines
Prioritize assignments and work within standardized policies and procedures to achieve objectives and meet deadlines
Work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions
Identify, evaluate and resolve standard problems by selecting appropriate solutions from established options
Ensure the privacy of each patient’s Protected Health Information (PHI)
Build collaborative relationships with peers and other staff members to achieve departmental and corporate objectives

Nice To Haves

1 year as typically acquired in a healthcare or insurance environment.

Responsibilities

Assisting participants and their families/ caretaker(s) in the annual redetermination process for Medicaid
Providing participants with resources and assisting in necessary paperwork/documentation of all necessary forms
Providing financial counseling to patients and their families
Assisting with insurance verification and eligibility, assessment of patient financial requirements and insurance policies
Proactively identifies participants coming up for Medi-Cal redetermination and Medicare eligibility
Understands and can communicate effectively procedures for Share of Cost, Long Term Medicaid and Spousal Impoverishment
Educate and assist participants with the completion of all necessary forms, and ensure appropriate signatures are obtained
Conduct visits in the center and to participants’ homes to complete forms
Assist with obtaining all documentation required for eligibility determination or redetermination
Complete and file applications by initiating and maintaining proper follow-ups with participants, center staff, and government agencies to ensure timely processing and completion of all mandated applications and accompanying documentation
Ensures compliance with DHCS and CMS policies and procedures and maintains a strong working relationship with agencies
Completes disenrollment paperwork, with participants, as necessary
Processes eligibility, enrollment and disenrollment to government agencies and within the electronic medical record and documents activities and transactions
Verifies eligibility and reconciles to census