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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. Business hours are as follows:

• 5:00 am to 5:00 pm PT
• 6:00 am to 6:00 pm MT
• 7:00 am to 7:00 pm CT
• 8:00 am to 8:00 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

1. 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.

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
* 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.

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Why Claritev?

Healthcare is complex. We help make it clearer.

At Claritev, you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise. We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here.

What Guides Us

At Claritev, innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.