Patient Advocate Representative

TakeCare Insurance Company, Inc.•Tamuning, GU

1d•Hybrid

About The Position

The Patient Advocate Representative functions as a Patient Representative and Advocate for TakeCare members. This role is responsible for receiving, documenting, researching, and responding to member inquiries regarding eligibility, coverage, coordinated care, and billings. The representative will gather and present relevant data for care management and coordination reviews, coordinate problem resolution among internal departments and external resources, and educate members on benefit coverage and processes. Additionally, this role supports the Medical Management team in care coordination and service approval, and assists in preparing monthly statistic reports.

Requirements

Graduate of associate degree or four (4) year course or work experience equivalence
Working knowledge of medical terminology
Must be able to demonstrate exceptional written/oral communication skills
Ability to interface with all sorts of people and handle difficult situations when necessary
Demonstrates superior customer service and problem solving skills as well as strong computer skills
Ability to maintain confidentiality
Minimum of 3 years’ experience in care coordination, member issue resolution, issue documentation and member communication.
Must have behavioral sensitivity, maturity, diplomacy and tact in complex situations and handling irate customers.
Must have basic familiarity on federal and state laws and requirements relating to healthcare management.
Strong ethics and a high level of personal and professional integrity.
Work independently with minimal to no supervision off-site if necessary.

Responsibilities

Functions as Patient Representative and Advocate for TakeCare members.
Communicates member-related coordination and coverage problems or issues with Medical Management, Claims, Customer Service and other departments as appropriate.
Assists in maintaining a list of members to ensure monitoring, reporting and timely written and/or verbal follow-up on all members’ coordination, coverage and billing complaints and issues.
Collaborates with other departments as needed for member satisfaction.
Supports the Medical Management team in care coordination and approval of covered services.
Communicates and interacts with members relating to their eligibility, coverage and care options on and off site.
Receives, documents, researches and responds to member inquiries, and issues relating to care coordination, service approval and claims billings.
Gathers and presents all relevant information relating to case and care coordination, medical review and provides recommendation for care coordination and approval pathway.
Prepares and/or initiates a variety of correspondence/documentation in response to inquiries, and issues relating to care coordination, service approval and claims billings.
Coordinates problem resolution for members, providers, and employer groups amongst various internal departments and external resources/contacts.
Educates members on benefit coverage, coverage and coordination processes, and claims billing.
Helps with the preparation of the monthly statistic reports for care coordination and referrals for Dashboard reporting to management.
Performs other duties that may be assigned from time to time.