Health Services Patient Advocate

Overview

Job Title: Health Services Patient Advocate

Department: Health Services

Reports To: Health Fund Operations Supervisor

FLSA Status: Local 153, Non-Exempt

 

Summary:

This position is a key part of developing, expanding, and maintaining the Health Services programs. The Health Services Patient Advocate is responsible for the maintenance of relationships with the 5 Star Centers, supporting the operations of the Health Fund Programs, responding to member and provider issues, and assisting members in choosing in-network providers, particularly 5 Star Centers.  The Health Services Patient Advocate works on issues from initial inquiries through completion and participates in marketing strategies and provide feedback for continuous quality improvement of the Health Services Team. Additionally, this position provides other operational support activities within the Health Services Team.

Principal Duties and Responsibilities:

Develop relationships with management and administrative staff at assigned 5 Star Center, including site visits
Assist members in choosing providers and scheduling appointments at 5 Star Centers
Assist with issue resolution as problems arise for assigned 5 Star Centers from initial inquiry through completion
Log member issues into the department tracking system
Assist members and act as advocates during complaint process with providers
Identify any patterns of fund program issues with service provision and address accordingly or notify management
Address member concerns  about Fund programs
Complete all program enrollment processes for eligible, interested members
Utilize Health Services Database to track interactions related to Fund programs
Work with members and the Providers to determine the correct copay and rectify all billing errors
Assist members to identify in-network specialists related to specific needs
Complete Targeted Outreach Projects

Reach out to members and dependents who meet specific criteria for upcoming Fund initiatives and or programs
Log interactions into funds tracking system
Administrative Functions

Receive incoming calls through the Health Services queue regarding Health Services Programs
Back up member services provider line queue upon request for provider search activity
Attend and participate in all team meetings
Qualifications and Core Competencies:

To perform the job satisfactorily, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill and/or ability required.

Excellent organizational and prioritizing skills
Ability to work on simultaneous projects with diverse working groups.
Ability to clearly communicate ideas and thoughts
Ability to work with minimal supervision and be an effective team player
Ability to effectively work in a fast-paced environment, handle multiple tasks and prioritize work
Excellent listening skills and ability to address member concerns
Ability to work well with physicians and other medical professionals
Ability to think creatively and implement solutions to meet member needs
The ability to read, write and understand English is essential.
Bilingual in English/Spanish is preferred
Education and/or Experience:

High School Diploma
Associates Degree or equivalent work experience in the healthcare industry preferred
Microsoft Office with emphasis on Word and Excel
Strong knowledge base of healthcare industry and medical terminology
Insurance/managed care and claims processing background a plus.