The Member Advocate II position will function as the resource for nonclinical patient support for the Centers of Excellence (COE) and nontraditional TPA lines of business, patients and services.
* Document all communications, recording the action taken and the resolution in HDP software system.
* Educate patients on program and respond to member questions and issues in a timely fashion, always showing care and concern.
* Review and prioritize incoming facility, member and vendor communication to appropriately triage work activity.
* Participate in client and/or partner meetings to support account management activities, facility implementations and operations.
* Assist in training new member advocates and be a resource for other departments.
* Participate in audit and quality initiatives and process improvements.
* Resolve issues as appropriate and/or alert staff of concerns, providing solutions for consideration.
* Coordinate travel functions and ensure scheduled travel is within parameters. Communicate with patients, third party travel partners and COEs.
* Track the progress of members through the program, acting as a liaison between departments, establishing priorities and deadlines.
Additional Duties (If applicable)
* Financial Support
o Calculate and coordinate member stipends according to client specifications.
o Audit invoices and expenses related to travel to validate accurate billing. Identify and resolve errors as needed.
o Prepare taxable income statements given to members or clients.
* Clinical Support
o Contribute toward daily operations of COE program by assisting COE Nurse Case Managers with tracking of patients through the program.
o Triage and respond to incoming clinical phone calls or emails from carriers, vendors or navigators by providing information and assistance to meet their needs.
o Ensures submitted Plan of Cares are consistent with contracted covered services and meets program parameters and processes Plan of Cares accordingly.
o Requests, collects, documents and processes clinical documentation received from COE providers.
* The ideal candidate will have a minimum of two years experience in a customer service or client service support role. Background in the medical or health insurance industry a strong plus.
* Knowledge of customer service principles and practices.
* High level of computer proficiency required; Microsoft Office, software systems/data entry.
* Must demonstrate a high level of interpersonal skills (written/verbal) to effectively communicate with a variety of individuals, including clients and patients
* Must demonstrate the ability to multi-task, prioritize work, meet deadlines, and have attention to detail.
* Must have the ability to appropriately handle sensitive or confidential information
* Must possess strong organizational skills, with the ability to prioritize and coordinate work tasks.
* Medical Assistant preferred for clinical support.
* Fluency in Spanish a plus, but not required.
Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity.