Patient Advocate

This position is primarily responsible for helping Managed Care (MC) patients with complaints, service issues, and optimizing their MC plan benefits. The role focuses on attracting and retaining patients through excellent customer service, both over the phone and in person.

Responsibilities

• Make outbound welcome calls to new Medicare Advantage patients monthly to educate them on their health plan benefits, GMG services, and the Patient Advocate role.
• Schedule new patients for intake and initial PCP visits from new enrollment lists, matching them with a GMG provider and Medical Center based on individual needs.
• Schedule, cancel, and reschedule daily appointments for all GMG physicians and mid-level providers using the Athena system.
• Compare current specialists and prescription medications to network providers and formulary; assist patients in transitioning to plan specialists and formulary medications.
• Guide patients on accessing their Medicare Advantage value-added benefits.
• Answer incoming calls to the Patient Advocate queue to assist with customer service, health plan, and care-related issues.
• Assist patients in the office with customer service, health plan, and service issues.
• Process prescription refill requests per GMG guidelines.
• Provide information about community resources to support patients' healthcare and social needs.
• Process registration of all new patients, including obtaining necessary data, verifying insurance coverage, and creating patient charts.
• Assist patients in preparing insurance, disability, and claim forms requiring PCP signatures.
• Verify insurance eligibility for Medicare Advantage patients on multiple insurance platforms.
• Accurately document pertinent patient information in clinic practice management systems.
• Assist providers and staff with questions regarding Medicare Advantage plans and benefits.
• Travel to smaller clinics as scheduled to assist patients, both scheduled and walk-in.
• Manage an in-house prescription copay assistance program.
• Schedule transportation for patients' medical appointments through multiple insurance benefit providers or public transportation.
• Assist Medicare Advantage patients with changing their PCP selection at the insurance level by phone or paper form.
• Maintain strict member and company confidentiality.
• Perform other duties as assigned by supervisor.

Requirements

• Perform duties accurately and in a timely manner.
• Maintain healthcare professional competencies according to Gonzaba Medical Group policy.
• Ensure customer service is maintained at the highest level at all times.
• Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.
• Adhere to customer service expectations in both in-person and virtual (telephone, telehealth) communications.
• Bilingual in English/Spanish is preferred.
• Participate in educational programs as needed.
• Work closely with other GMG departments to ensure timely and accurate handling of patient requests.
• Possess and maintain a current valid Texas Driver License and proof of insurance for mileage reimbursement (position requires driving a company or personal vehicle).
• Successfully complete a motor vehicle history check.

Work Environment

Depending on assignment, the role may be in a 100% clinical setting or an office setting within a clinical environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment may occur.

Physical Requirements

• Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, and walking.
• Ability to lift up to 10 lbs.
• Close vision and ability to adjust focus.
• Must be able to work efficiently under pressure.