The Healthcare Advocate works directly with individuals and their care team to achieve optimal health and wellness goals. The care team can consist of their care giver(s), provider(s), community health care team, and more. This position description applies to full-time and part-time remote Healthcare Advocates.
- General knowledge of claims/billing; benefit support, healthcare navigation; healthcare resources; provider resolutions/communication; behavioral health; disease support; transition of care; end of life support; medication/pharmacy; social determinants of health, etc
- Answers incoming calls and responds to client inquiries. Places outbound calls for follow-up.
- Excellent listening skills.
Build trust and rapport with each person to help navigate their personal health and wellness journey for their desired outcomes.
- Provides education, advocacy, resource access, and targeted support to assist individuals and their care team. Help individuals and their care team understand their clinicians’ diagnoses, evaluations, and treatments plans related to their medical conditions, labs, prescriptions, tests, health and community services, appointments, follow-up care, discharge instructions, end of life support, and related care plans.
- Provides effective communication between individuals, their caregivers, and their healthcare and community care providers.
- Explores choices regarding medical providers and services, employee benefits, and community services based on needs, goals, geography, and eligible benefits.
- Assists individuals with medical bills, EOBs, fee negotiations, and payment plans.
- Provides emotional support to individuals and their care team.
- Develops and maintains working relationships with community agencies.
- Acts as a neutral liaison for individuals and their care team.
- Informs individuals and care team representatives of their rights and responsibilities.
- Mentor team members.
- Protects the confidentiality of healthcare information through compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH).
- Completes annual and periodic training.
- Maintains professional credentials.
- Performs other duties as assigned.
Must be detail-oriented and knowledgeable of medical procedures, such as diagnosis and treatment methods. Must have a proven ability to navigate the healthcare system.
- 3-5 years clinical, healthcare experience and/or medical management experience
- LPN/LVN, Registered Nurse, Social Work, or other healthcare-related fields from an accredited college or university.
- BCPA preferred. Willing to obtain certification within 18 months of employment.
- Ability to work closely with all types of individuals, including providers and payors.
- Excellent telephonic listening and speaking skills.
- Ability to organize and coordinate multiple simultaneous tasks in a team environment.
- Strong communication skills and phone etiquette
- Strong understanding of medical terminology
- Ability to follow complex written and oral instructions.
- Ability to collect data, distinguish relevant material, and exercise sound judgment.
- Problem-solving, negotiating, and customer resolution skills.
- Ability to maintain objectivity.
- Strong computer skills
- Ability to read and write in standard, plain English language. (Clear, concise, and well-organized)
- Ability to work independently with minimal supervision.
- Ability to communicate accurately, consistently, timely, clearly, empathetically, respectfully, and effectively with individuals, representatives, and providers, both verbally and in writing.
- Bilingual preferred
Organizational “Fit” Considerations:
Schedules may vary and may include weekends and holiday shifts. Requires established, professional relationships internally with people at all levels, physicians, and others outside the company.
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