Patient Authorization Advocate

HopeHealth Inc

About The Position

Under the administrative supervision of the Patient Care Advocate Manager, the Patient Authorization Advocate is responsible for securing authorizations for ordered services and coordinating care across patients, providers, imaging facilities, and specialists. This role functions as a key liaison to ensure efficient communication, facilitate access to care, and support a seamless patient experience.

Requirements

Ability to utilize computer software equipment and maintain basic excel spreadsheets, logs, and records for data collection purposes.
Ability to work as part of a team and with the health care providers
Enhanced knowledge of insurance and medical terminology, including understanding of ICD-10 and CPT codes
Honesty and genuine compassion for the individuals living with healthcare disparities
Ability and willingness to accept direction from supervisor
Good written and verbal communication skills
Ability to take initiative and handle various tasks simultaneously while working efficiently, effectively, and independently without direct supervision
Hearing: Adequate to perform job duties in person and over the telephone.
Speaking: Must be able to communicate clearly to patients in person and over the telephone.
Vision: Visual acuity adequately to perform job duties, including reading information from printed sources and computer screens.
Other: Requires occasional lifting and carrying items weighing up to 10 pounds unassisted. Requires frequent bending, reaching, and repetitive hand movements (especially if keyboarding and writing), standing, walking, squatting, and sitting, with some lifting, pushing and pulling exerted regularly throughout a regular work shift.

Nice To Haves

A four-year degree in a related field is preferred or equivalence
Four years related experience; equivalence acceptance to be determined by supervisor

Responsibilities

Collaborates with the care team to support coordinated, patient-centered care.
Serves as a patient advocate, building trust and guiding patients through the authorization process.
Obtains prior authorizations and pre-certifications for ordered services using clinical documentation from patient records.
Communicates authorization status, insurance requirements, and next steps to patients in a clear and timely manner.
Maintains working knowledge of insurance guidelines to ensure services are authorized and covered when applicable.
Acts as a liaison between patients, providers, and insurance representatives to facilitate timely approvals and resolve issues.
Reviews patient charts and gathers necessary clinical information to support authorization requests.
Documents all authorization activities, patient interactions, and related communications accurately in EMR systems.
Follows up on pending authorizations and communicates updates to ensure continuity of care.
Addresses patient inquiries and concerns, ensuring a professional and supportive experience.
Assists with scheduling appointments as needed, considering patient preferences and insurance requirements.
Obtains medical records from external organizations when necessary to support care and authorization needs.
Escalates authorization or care concerns to appropriate staff when needed.
Participates in Continuous Quality Improvement (CQI) initiatives to enhance processes and care quality.
Ensures compliance with HIPAA and maintains confidentiality at all times.
Maintains an organized and professional work environment.
Performs other duties as assigned.