Patient Advocate

3 days ago


Fort Worth, Texas, United States SUITEMATE STAFFING SOLUTIONS INC Full time
Job Summary

At SuiteMate Staffing Solutions Inc, we are seeking a highly skilled Community Health Worker-Member Advocate to join our team. As a Community Health Worker-Member Advocate, you will serve as a liaison between our members and the medical plan, helping them navigate the complexities of the healthcare system.

Key Responsibilities
  • Member Advocacy
    • Build rapport with members and their legally authorized representatives by responding to their inquiries in a respectful and timely manner, following all policies and procedures.
    • Act as an advocate for the member and a liaison between the health plan and other entities to ensure availability and access to healthcare.
  • Community Outreach
    • Promote member education, identify and resolve any systemic barriers that limit members' access to appropriate care.
    • Serve as a primary contact for member advocacy groups, human services agencies, and state entities.
  • Education and Support
    • Provide member education regarding member rights and responsibilities, complaints and appeal processes, medically necessary covered services, non-capitated services, and linguistic services.
    • Translate educational and healthcare needs and act as a liaison for members/LARs.
  • Issue Resolution
    • Coordinate issue resolution, work with other plan departments as needed to resolve member complaints/grievances and member inquiries, ensuring that all information is collected and documented accurately and sent in a timely manner to the Compliance Department.
    • Receive and respond to member complaints and formal grievances.
Requirements
  • Language Skills
    • Must be bilingual with fluency in both English and Spanish, with excellent oral and written communication skills.
    • Must pass a Spanish proficiency examination prior to hire.
  • Experience
    • Must have 1-2 years' experience in community outreach or member advocate services.
    • Must have 1-2 years' experience working with health insurance in a health plan setting and be knowledgeable of health insurance terminology.
  • Skills
    • Excellent oral and written communication skills are a must, as will be required to draft member educational materials.
    • Prioritizing and time management skills are a must.
    • Strong problem-solving skills and the ability to make independent decisions, including the ability to manage difficult callers and resolve any departmental conflicts that may arise.
    • Required to work independently as well as within a team environment.
    • Efficient in Microsoft Office (Word, Excel, Access, Outlook, PowerPoint), including the ability to document quickly and accurately in between calls.
  • Licensure, Certification, or Registration Required
    • CHW License required upon hire.


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