Patient Advocate

Gonzaba Medical Group•San Antonio, TX

1d•Onsite

About The Position

This position is primarily responsible for helping our Managed Care (MC) patients with complaints, service issues, and optimizing their MC plan benefits. This position helps patients over the phone and in person. The primary purpose is to attract and retain patients to the practice through excellent customer service. This position is primarily responsible for customer service related to specific Medicare Advantage patients, though helps any GMG patient with service needs/issues. Makes outbound welcome calls to all new Medicare Advantage patients monthly to educate patients regarding their Medicare Advantage health plan benefits, orient patients on GMG services and Patient Advocate role. Schedules new patients for Intake and initial PCP visit from new enrollment lists. Matches prospective patients with a GMG provider and Medical Center to meet their individual needs. Schedules, cancels and reschedules daily appointments for all GMG physicians and mid-level providers using the Athena system. Compares current specialists and prescription medications to network providers and formulary; help patient transition to plan specialists and formulary meds. Assist and guide patients on how to access their Medicare Advantage value added benefits. Answers all incoming calls to the Patient Advocate queue to assist patients with customer service, health plan and care related issues. Assists patients in the office with customer service, health plan and service issues. Processes prescription refill requests per GMG guidelines. Assists patients with information about community resources available to support their healthcare/social needs. Process registration of all new patients includes obtaining all necessary data, verification of insurance coverage and creation of the patient charts. Assist patients prepare insurance, disability and claim forms that require PCP signatures. Verify insurance eligibility for Medicare Advantage patients on multiple insurance platforms. Accurately documents pertinent patient information in clinic practice management systems. Assists providers and staff with questions regarding Medicare Advantage plans and benefits. Travel to and from smaller clinics by schedule to assist patients either scheduled or walk-in. Manage an in-house prescription copay assistance program. Schedule transportation for patients medical appointments through multiple insurance benefit providers and/or various types of public transportation. Assist Medicare Advantage patients with changing their PCP selection at the insurance level by phone or paper form. This position will require driving a company vehicle or a personal vehicle; therefore, employees must successfully complete a motor vehicle history check, possess, and maintain a current valid Texas Driver License, and proof of current insurance to be subject for mileage reimbursement. Maintains strictest member and company confidentiality.

Requirements

Minimum high school diploma or equivalent required.
Excellent computer skills, knowledge of Word Processing software, database software, spreadsheet and Internet software.
Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
Must successfully complete a motor vehicle history check.
Must possess and maintain a current valid Texas Driver License.
Must provide proof of current insurance for mileage reimbursement.

Nice To Haves

Bilingual in English/Spanish is preferred.
Minimum 5 years’ experience in a healthcare setting preferred.
Three years of customer relations experience preferred.
Experience with Medicare Advantage plans or referrals, familiar with a variety of the field’s concepts, practices, and procedures preferred.

Responsibilities

Helping Managed Care (MC) patients with complaints, service issues, and optimizing their MC plan benefits.
Attracting and retaining patients to the practice through excellent customer service.
Making outbound welcome calls to new Medicare Advantage patients monthly to educate them about their benefits and GMG services.
Scheduling new patients for Intake and initial PCP visits.
Matching prospective patients with a GMG provider and Medical Center.
Scheduling, canceling, and rescheduling daily appointments using the Athena system.
Comparing current specialists and prescription medications to network providers and formulary, and assisting patients in transitioning.
Assisting and guiding patients on accessing their Medicare Advantage value-added benefits.
Answering incoming calls to the Patient Advocate queue for customer service, health plan, and care-related issues.
Assisting patients in the office with customer service, health plan, and service issues.
Processing prescription refill requests per GMG guidelines.
Assisting patients with information about community resources.
Processing registration of all new patients, including data collection, insurance verification, and chart creation.
Assisting patients with preparing insurance, disability, and claim forms.
Verifying insurance eligibility for Medicare Advantage patients on multiple platforms.
Documenting pertinent patient information in clinic practice management systems.
Assisting providers and staff with questions regarding Medicare Advantage plans and benefits.
Traveling to and from smaller clinics to assist patients.
Managing an in-house prescription copay assistance program.
Scheduling transportation for patients' medical appointments.
Assisting Medicare Advantage patients with changing their PCP selection.
Driving a company or personal vehicle (requires motor vehicle history check, valid Texas Driver License, and proof of insurance).
Maintaining strict member and company confidentiality.