What are the responsibilities and job description for the Patient Advocate Representative position at Claritev?
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
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 of the process and negotiations for closing out the balance bills.
JOB ROLES AND RESPONSIBILITIES :
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.
