Patient Advocate Associate

Job Description

Job Description

Description : Job Purpose

Job Purpose

A day in the life of an H-Wave Patient Advocate Associate consists of seeking and obtaining authorization for patient demonstrations while educating, building relationships, and influencing insurance adjusters and nurse case managers.

This is achieved by being proactive, thinking ahead, and reacting quickly with sound decision-making ability.

Duties and Responsibilities

• Through the pre-authorization phase educate Claims Adjusters and Nurse Case Managers throughout the pre-authorization phase, on the benefits and programs associated with the H-Wave.
• Review incoming claim correspondence and ensure appropriate action steps are taken when response is needed.
• Contact insurance adjusters and nurse case managers (payors) to request authorization for patient demonstrations.
• Identify proactive approaches to determine patient eligibility, including patient advocation and patient or attorney contact.
• Regularly and timely follow ups with payors regarding authorization decisions.
• Review and identify utilization review approvals, denials and modifications and ensure appropriate next action steps are taken.
• Develops and cultivates strong relationships, both internally and externally.
• Maintain knowledge of medical and legal terminology applicable to the workers compensation and auto claims vertical markets.
• Maintain up-to-date knowledge of regional-specific processes and procedures.
• Maintain up-to-date knowledge of the total care program while proactively selling and negotiating with Payor representatives.
• Timely and regular follow-up on total care agreements and ensuring appropriate payment has been received.
• Maintain up-to-date knowledge of state labor codes and guidelines including Laws governing collection efforts for durable medical equipment (H-Wave) and continuing education workshops to gain more skills yearly.
• Delivers excellent customer service and meets the needs of all our customers while executing high-volume calls.
• Identify trends pertaining to authorizations, denials, and preferred vendors, while communicating these trends to applicable team members and departments.
• Report weekly workflow to their Regional Operations Manager and Regional Operations Supervisor.
• Enter, maintain, and follow up on patient support requests in a timely manner.
• Enter all patient applications that are processed on the initial and continued authorization grading tracker, while providing analysis on the medical documentation we have received.

Requirements : Qualifications

Qualifications

• 1 year of previous customer service experience in a call center or medical industry
• Basic knowledge of Microsoft Office Suite Products : Outlook, Excel, PowerPoint, SharePoint
• Excellent customer service and ability to meet the needs of all our customers
• Demonstrated ability to actively manage multiple priorities and adapt to change within a fast-paced business environment

Physical Requirements

This is a stationary position that requires frequent sitting or standing, repetitive wrist motions, grasping, speaking, listening, close vision, color vision, and the ability to adjust focus.

It also may require occasional lifting, carrying, walking, climbing, kneeling, bending / stooping, twisting, pulling / pushing, walking, bending, stooping, and reaching above the shoulder.

Employees in this position must be physically able to efficiently perform the essential functions of the position. Reasonable accommodations will be provided to assist or enable qualified individuals with disabilities to perform the essential functions of the position, upon request