Patient Advocate Representative
Remote Positions Available
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. Work schedules are as follows:
- 5:00 am to 2:00 pm PT
- 6:00 am to 3:00 pm MT
- 7:00 am to 4:00 pm CT
- 8:00 am to 5:00 pm ET
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.
2. Reviews and resolves balance bills and appeals with providers, through negotiations.
3. Identifies troubled facilities for potential direct contracting and redirection.
4. Ensures clear documentation of events associated to a claim resolution.
5. Provides updates and solicits required information from clients as needed.
6. Keeps direct report informed of critical matters that impact responding timely to appeals/balance bills.
7. Manages a daily running inventory of claims, prioritizing one’s work schedule accordingly.
8. Addresses emails and incoming calls.
9. Ensures member inquiries are addressed timely, including education.
10. Participates in on-going process improvement to develop efficiencies that streamline the process and the Patient Advocacy Center.
11. Collaborates, coordinates, and communicates across disciplines and departments.
12. Ensures compliance with HIPAA regulations and requirements.
13. Demonstrates Company’s Core Competencies and values held within.
14. Please note due to the exposure of PHI sensitive data — this role is considered to be a High Risk Role.
15. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary.
JOB SCOPE: This position works independently under minimal supervision to complete the assigned job responsibilities. Work performed is often varied and complex, requiring a reliance on a knowledge base built through experience. The incumbent follows established procedures and uses knowledge of the company’s general business principles, industry dynamics, market trends, and specific operation details when performing the duties of the position as assigned.
COMPENSATION
The salary range for this position is $25 to $30 per hour. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
Qualifications
REQUIREMENTS
* Minimum high school diploma. Baccalaureate degree (BA/BS) from an accredited college or university preferred.
* Two (2) plus years’ experience in a medical healthcare claims role dealing with facilities, providers and members is required.
* Background in healthcare claims management environment including provider hospital billing, claims adjudication and administration or the ability to interpret benefit plans/Explanation of Benefits
* State licensure certification, including NY Health and/or P&C State Adjustor license, may be required. If hired without certification, certification must be obtained, and maintained thereafter, within six months of notification. If the required state licensure certification(s) are not obtained or renewed within six months of notification, an employee may be moved to a position within a relevant job family that does not require certification/licensure, if and when such position is available. When an alternate position is unavailable, other employment actions may be implemented consistent with Claritev practice and policy.
* Negotiation experience a plus
* A proactive, self-starter
* An elevated level of professionalism, organization, and flexibility
* Strong organizational skills, demonstrating strong attention to detail.
* Effective communication skills, both oral and written
* Excellent organizational skills demonstrating strong attention to detail.
* Ability to manage high call volume.
* Ability to multi-task effectively
* Detail focused.
* Self-Motivating personality and a professional demeanor that promotes a team environment.
* Manages self and time so as to meet provided timeframes and deadlines, becoming flexible when necessary.
* Able to work comfortably in a fast-paced environment.
* Solid problem solving skills with the ability to determine and take the appropriate course of action for resolution.
* Should possess a moderate to elevated level of claim editing, coding, RVU and CMS-based pricing knowledge with an emphasis in researching solutions for the above items as needed.
* Bilingual preferred
* PC literate, including Microsoft Office products and web-based applications.
* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier, and telephone.
* Regular, timely attendance
State licensure certification, including NY Health and/or P&C State Adjustor license, may be required. If hired without certification, certification must be obtained, and maintained thereafter, within six months of notification. If the required state licensure certification(s) are not obtained or renewed within six months of notification, an employee may be moved to a position within a relevant job family that does not require certification/licensure, if and when such position is available. When an alternate position is unavailable, other employment actions may be implemented consistent with Claritev practice and policy.
BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
- Medical, dental and vision coverage with low deductible & copay
- Life insurance
- Short and long-term disability
- Paid Parental Leave
- 401(k) + match
- Employee Stock Purchase Plan
- Generous Paid Time Off – accrued based on years of service
- WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
- 10 paid company holidays
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits
EEO STATEMENT
Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.
APPLICATION DEADLINE
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.
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