Health Services Patient Advocate - Spanish Bilingual

Job Description

Job Description

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.