Patient Advocate
3 days ago
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.
- 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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