Patient Advocate
Responsibilities
As a Patient Advocate, you will be responsible for matching the daily volume of incoming client claims to the correct provider using an in-house web-based application. This position may be located anywhere in the Eastern, Central, Mountain or Pacific time zones. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High-Risk Role. The position works independently under minimal supervision to complete the assigned job responsibilities; work performed is often varied and complex, requiring reliance on a knowledge base built through experience, following established procedures and using knowledge of the company's general business principles, industry dynamics, market trends, and specific operation details.
Job Summary
This role is responsible for handling member, client, and provider inquiries (balance bills and appeals) based upon an assigned client base. This person is responsible for addressing member calls related to balance billing situations, educating the process and negotiations for closing out the balance bills.
Duties
- Manages facility, provider, and member inquiries, appeals and balance billing, including correspondence.
- Reviews and resolves balance bills and appeals with providers, through negotiations.
- Identifies troubled facilities for potential direct contracting and redirection.
- Ensures clear documentation of events associated to a claim resolution.
- Provides updates and solicits required information from clients as needed.
- Keeps direct report informed of