Job Description

Schedule: Monday-Friday 8am-5pm

Pay Range: $18.35-25.00 per hour, dependent on level of education

Under direction of the Value Based Care (VBC) Leadership, the Patient Advocate provides and facilitates communication of basic health information, and performs clerical, clinical documentation, including insurance information benefits for support services for patients in VBC. Serves as telephonic and clerical support for the VBC patients and provides services such as appointment scheduling and medical record retrieval. Provides basic social services and application assistance for VBC patients as needed and is responsible for ensuring billing and documentation is complete for VBC patients. The Patient Advocate also assists in the development and implementation of patient campaigns for health risk assessments, annual wellness visits, and other prevention strategies as designated by the VBC leadership.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Serves as the first point of contact for inbound call campaigns for Emergency Department and Ambulatory Care Sensitive Condition follow up.
• Completes outbound telephonic campaigns for annual wellness visits, health risk assessments, and other quality improvement measures as assigned and directed.
• Facilitates reminder calls for appointments, labs, diagnostics and outstanding quality improvement measures.
• Uploads hospital records from hospital electronic medical record (EMR) to Athena for new admissions/discharges. Calls and faxes requests for inpatient and post-acute records from facilities when EMR access is limited or not obtainable.
• Assists the VBC patients with coordinating new referrals for patients post discharge to ensure the specialist receives the referral, supporting clinical documentation, and authorization. Ensures the patient is given a timely appointment from the specialist and follows up after the appointment to ensure records are uploaded to the patient's Athena chart and placed in review to the Primary Care Provider.
• Assists with coordinating start of care with Home Health Agencies as needed.
• Interacts with Home Health Care agencies and SNFs for patient status and Discharge plan
• Serves as the point of contact for all Value Based Care patients that do not have an assigned care manager.
• Assist patients with appointment scheduling with the PCP, specialists, and testing facilities.
• Facilitates reminder calls for appointments, labs, and outstanding quality improvement measures.
• Interacts in a professional manner with patients, staff, and external customers.
• Completes telephonic campaigns for annual wellness visits, health risk assessments, and other prevention campaigns.
• Ensures billing is complete for VBC patient care plans.
• Athena labeling maintenance: marking the charts of newly attributed VBC/DCE patients. Unmarks the charts of those termed/deceased patients. Maintaining VBC patient lists inside of the population health tool for newly assigned and termed patients.
• Completes the deceased and hospice patient workflows.
• Schedules new patients "First "appointment and Annual Wellness Visit appointments
• Validates patient insurance for VBC patients and updates in Athena
• Assess for SDOH within Athena
• Educates/offer assistance on state's Medicaid programs
• Identifies patients for conversion into VBC Medicare Advantage and/or Medicaid (Duals) plans by using the "Age-in" report by sending birthday cards
• Participates in pertinent meetings and workshops as directed.
• Interacts with respect and in a professional manner with patients, staff, and external customers
• Follows HIPAA and OSHA Standards and guidelines.
• Maintains HR compliance and procedures.
• Ensures patient satisfaction by providing excellent service putting "patients first always"
• Other duties as assigned

KNOWLEDGE/SKILLS/ABILITIES:

The Patient Advocate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.

A general knowledge of primary care practice, clinics, hospitals, specialists, and ancillary health services and basic knowledge of legal and ethical standards for the delivery of primary care and medical terminology. Must have personal effectiveness and credibility, collaborative skills, communication proficiency and flexibility.

Must be able to work independently and as a team player. Uses reason and speaks clearly, respectfully, and persuasively in positive and negative situations, focusing on resolving conflict.

Must demonstrate strong decision making and documentation skills.

Possesses organizational and problem-solving skills: Identifies and resolves problems in a timely manner; gathers, analyzes, and communicates information skillfully; develops alternative solutions in an organized manner.

Knows, understands, and works within the scope of his/her practice. Able to delegate responsibilities appropriately to staff licensure, education, and experience.

Able to work independently and in a multidisciplinary team. Keeps leadership informed and seeks advice and/or help from management whenever needed.

Able to manage difficult or emotional customer service situations and responds to requests for customer service and assistance in a timely and appropriate manner.

Shows respect and sensitivity for cultural diversity, promotes a harassment-free environment, and fosters a non-discriminatory climate.

Keeps commitments; inspires the trust of others; works with integrity and ethically.

Adapts to changes in the work environment and demonstrates willingness to change approaches or methods as needed to best fit the situation within practice guidelines.

Qualifications

EDUCATION AND EXPERIENCE REQUIREMENTS

• 2 to 3 years professional experience working in a primary care or post-acute setting OR 2 to 3 years of patient navigation, referral management or health education experience.
• Certified Medical Assistant, Health Coach, or Associate or Bachelor's Degree in a related area
• Strong computer skills and proficiency in internet software and knowledge of Microsoft Office products required
• Able to effectively utilize an electronic health record
• Basic knowledge of Medical Insurance is preferred
• Basic knowledge of Medicare plans including Medicare Advantage (MA) HMO, PPO, C-SNP, D-SNP; Duals) is preferred
• Athena EHR experience preferred

WORKING ENVIRONMENT

The position requires climbing, stooping, kneeling, crouching, reaching, standing, lifting, grasping, feeling, talking, hearing, repetitive motions, and finger use. Pushing and pulling are occasionally required. Use of a computer, keyboard, and telephone along with various office machines is an essential part of the job.

DISCLAIMER

The above statements are intended to describe the general nature and level of work being performed by the Patient Advocate. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The Patient Advocate may be required to perform duties outside of their normal responsibilities from time to time as needed or as directed by supervision.