Patient Advocate Jobs

About The Position

Requirements

• High school diploma plus one to three years office/business experience, call center experience preferred and/or claims processing experience preferably in managed care with possible enrollment experience
• Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, physician office staff.
• Written communication skills as well as business writing and presentation skills are required.
• Requires strong organizational skills, ability to create, sort and analyze reports (Excel, Access, etc) and system processes.
• A thorough knowledge of reimbursement methodologies i.e. DRG, Relative Value Systems, Per Diem, Fee schedule, Capitation, etc and some knowledge of risk sharing programs helpful.
• Some knowledge of CRM and EPIC as well as any other databases that may be used PHS Enterprise wide.
• Demonstrated ability to function effectively as a team member.
• Requires ability to retain plan details and basic medical terminology.
• Must be able to work cooperatively with other employees and function under pressure.
• Demonstrated ability to sustain quality standards.
• Ability to type 30 wpm with 90% accuracy.

Responsibilities

• Responsible for providing customer service for patients in regard to the triage of patients, scheduling appointments, referrals, messaging, and maintaining patient demographics.
• Respond to incoming calls routed through skill-based technology to meet quality standards and performance measurements.
• Is ready to take calls at the scheduled time, and spends the appropriate amount of time taking calls throughout their shift to resolve contacts on initial encounter.
• Conducts outbound calls as required and meets established quality/quantity guidelines supporting PHS/PHP/PMG initiatives and/or programs.
• Develop and maintain positive customer or partner relationships.
• Acts as member/patient advocate in dealing with practitioners, employer groups, and brokers.
• Maintains prescribed standards of quality in all research, customer and partner contacts/service functions and promotes customer satisfaction/loyalty through quality contact and timeliness of responses, achieves quality audit results as required.
• Assists in the development of documentation of process and procedures into functional process improvements to enhance overall level of service to our customers and partners.
• Uses the Improvement model, identifies patterns in call inquiries/grievances, conducts root cause analysis in resubmitted and adjusted claims and reports to management team.
• Researches inquiries/special projects as requested and responds to customer, partner or other PHS/PHP business units to ensure accuracy of benefit interpretation with results of research and resolution and within required timelines.
• Responses to customer or partners to be done using Microsoft Word, Excel or similar databases when appropriate.
• Uses available documentation such as D.A.R.T., Provider Manual, Pres Online, and Policies and Procedures to analyze and provide accurate and consistent information and benefit interpretation.
• Participates as an effective and active team member both individually and in a team environment.
• Participates in a value-added manner as a team member to internal teams as well as other process improvement teams (i.e. QCC) and initiatives.
• Record all calls, mail, email, faxes, walk-in encounters, etc. in appropriate databases to provide meaningful, accurate data for analysis and reporting.
• Assist in coordinating (when necessary) meetings with customers or partners for training, contracting, and reporting.
• Coordinates the encounter or episode process for the customer/patient including scheduling, registration, co-pay collection, financial arrangements, charge posting, and reconciliation of monies collected.

Benefits

• All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being.
• Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.