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Patient Advocacy Specialist

2 months ago

Reno, Nevada, United States Renown Health Full time

Position Overview

This role serves as the primary point of contact for individuals seeking healthcare services, ensuring that they receive timely assistance while delivering an outstanding customer experience. The individual in this position will act as a patient advocate, facilitating communication between Renown Health, its clients, and community stakeholders by addressing inquiries, resolving complaints, and providing guidance on utilizing the organization's resources effectively, ultimately achieving 'first call resolution'. A successful representative is dedicated to exceeding expectations and providing a professional, efficient, and proficient service. This role is fulfilling as it allows for a meaningful impact on the lives of those served.

Key Responsibilities

The representative will operate in a dynamic environment, utilizing various communication methods including in-person interactions, video calls, phone conversations, chat, messaging, and email. Mastery of relevant systems and technologies is essential, alongside the ability to multitask effectively.

Strong interpersonal skills are crucial for understanding customer inquiries or issues and navigating potentially challenging conversations. Representatives must maintain high service standards while managing complex situations and high volumes of interactions. They will represent the voice of the customer, advocating for their needs to ensure top-tier service by proactively identifying and escalating priority issues, de-escalating when necessary, and striving to meet customer requirements. Quick learning is essential to acquire the necessary knowledge of services and products to provide accurate responses. Documentation must be precise and thorough, adhering to proper grammar and complete sentences.

Remote shifts are scheduled consistently, and representatives are expected to be present for their entire shift in a quiet, private environment that complies with HIPAA standards. Flexibility in working hours, including evenings, nights, weekends, and holidays, may be required to meet customer demands.

The representative will deliver a variety of services, including but not limited to:

  • Providing exceptional service through a foundational understanding of all services offered by Hometown and Renown Health.
  • Adhering to established policies and procedures to fulfill tasks, address customer needs, and achieve one-call resolution.
  • Managing a high volume of inbound and outbound communications across multiple channels and software systems, effectively resolving customer inquiries.
  • Coordinating healthcare services such as appointment scheduling, updating patient records, obtaining authorizations, liaising with care teams, arranging transportation, and addressing patient concerns.
  • Responding accurately to customer inquiries regarding plan benefits, including eligibility, benefit details, provider networks, referral processes, claims payments, and relevant policies.
  • Collaborating effectively with healthcare professionals, including providers, social workers, case managers, nurses, and insurance representatives.
  • Addressing inquiries related to compliance and regulatory standards.

Additional duties may be assigned as needed, and representatives are expected to meet and exceed performance metrics to support departmental and organizational objectives.

Qualifications

Education: Proficiency in the English language is required, encompassing reading, writing, and speaking. A college degree or equivalent experience is preferred but not mandatory.

Experience: Strong customer service skills are essential, with a preference for 1-2 years of experience in customer service, healthcare, or health insurance roles. Bilingual abilities, particularly in Spanish, are advantageous.

Technical Skills: Proficiency in Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and Word, is required. Ability to type at least 40 WPM and experience with electronic medical record systems is a plus.