Patient Advocate

Position Highlights

You Belong at Avera
Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients.
Work where you matter.

Responsible to

• Provide assistance to patients and/or families as they navigate through all aspects of their medical paperwork, including insurance, billing, payment and collection process.
• Screen patients to determine potential for program assistance, complete application with patient and families, and follow up after discharge regarding application and maintain knowledge base of community agencies and resources to facilitate appropriate referrals, including maintaining a thorough understanding of eligibility requirements and current laws governing government programs.
• Communicate with patients, families, case managers, and providers to assess care plans and corresponding coverage needs and work in a compassionate and tactful manner to help facilitate access to and provide continuity of care.
• Advocate for patients, families, and team members to help address insurance coverage gaps via alternative funding options including, but not limited to, help with completing applications for copay assistance, compassionate use drug and/or Avera Patient Assistance.
• Avoid billing errors by accurately documenting all interactions related to advocacy within the EMR.

Essential Qualifications

• The individual must be able to work the hours specified.
• To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.

What You Will Do

• Insurance Screening: Obtain detailed patient insurance benefit information for all aspects of cancer care, including, but not limited to, outpatient services and prescription drugs. Verify insurance coverage and other medical benefits and acquire necessary referrals and authorizations.
• Identify self-pay patients and evaluate coverage opportunities. Assist with completion of all needed applications for coverage, including applications for drug assistance. Provide accurate cost estimate details to patients prior to appointments. Discuss benefits and other financial concerns with patients and/or family members during initial referral and during continuation of care. Identify and effectively communicate financial information to team members, patients, and their families with emphasis on identifying any potential patient out-of-pocket liability.
• Assist patients with questions concerning insurance, coverage, and other financial issues. Document in patient record as appropriate. Obtain all necessary insurance authorizations. Obtain clinical information as needed from the medical record to answer clinical questions during authorization process.
• Communicate with care team and pharmacy staff to ensure that all treatments meet medical necessity. Draft medical necessity authorization request letters to include insurance contact information, patient history, and appropriate scientific literature. Manage both routine and complex insurance authorizations directly. Responsible for the coordination of level II appeals with oversight from the appropriate medical staff.
• Work with patients, their families and team members to help address insurance coverage gaps via alternative funding options including, but not limited to, help with completing applications for copay assistance, compassionate use drug and/or Avera Patient Assistance.
• Absorb and communicate financial information to team members, patients, and their families with emphasis on identifying any potential patient out-of-pocket liability.
• Manage both routine and complex insurance authorizations directly. Responsible for the coordination of level II appeals with oversight from the appropriate medical staff.
• Facilitate resolution of patient billing issues which may include appealing denied claims.
• Absorb and communicate financial information to team members, patients, and their families with emphasis on identifying any potential patient out-of-pocket liability.
• Work in collaboration with the patient, insurance, and business office.
• Work as a member of a team of Patient Advocates to assist in other oncology departments as needed.
• Work with multiple disciplines and departments to ensure clear communication and prompt delivery of treatment.
• Absorb and communicate financial information to team members, patients, and their families with emphasis on identifying any potential patient out-of-pocket liability.

Benefits

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement.
• Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law.