Job Description
Description Job Summary The Patient Advocate is responsible for communicating with payers and following up on member appeals. The Payer Advocate will communicate with patients about the status of their appeals and obtain additional information needed for appeals to include personal attestation letters or payer specific forms. The advocate will obtain medical records when additional documentation is required for appeals. The advocate will disperse mail correspondence to the department, communicate outcomes of the patient’s appeals, and update appeal tracking reports as needed. This position will report to Manager, Prior Authorizations on the Payer Operations department. The role is full time, exempt and will work remotely.
Essential Duties And Responsibilities The essential functions include, but are not limited to the following:
- Provide advocacy and support to patients who are denied insurance coverage for products
- Ability to engage patients when needed to participate in appeals
- Communicate with payers to follow up on appeal status for denied prior authorizations or claims appeals
- Assist the department with dispersing mail
- Communicate with the team members about appeal statuses
- Communicate with clinician offices to obtain medical records, required documentation and signatures that are needed to assist with the appeal process
- Maintain a high level of accuracy while meeting productivity and quality requirements
- Work with other departments to ensure accurate processing of
patient orders and payer approvals and denials
- Identify trends for process improvement and communicate to leadership
- Assist in the development of internal processes and best practices for the payer operations department
- Benefit and authorization process investigation
- Follow all compliance and HIPAA requirements
Other duties as assigned
Minimum Qualifications Education, Experience and Training
- Bachelor’s degree or equivalent work experience
- Previous experience in the medical device industry, Medicare appeals, clinical record review or related field
Knowledge, Skills And Abilities - Excellent written and verbal communication skills
- Excellent problem solving and analytical skills
- Ability to produce grammatically accurate appeal and patient correspondence
- High attention to detail
- Ability to work under pressure and deliver complete, accurate, and timely results
- Proven ability to work independently, multitask, prioritize and meet required deadlines
- Ability to be persuasive and credible with payers
- Working knowledge and expertise of insurance processes
- Technology savvy and able to navigate payer portal systems
- Ability to work independently and in collaboration with a team
- Able to provide clear and concise communication to payers, field reps, clinicians, peers and management via phone, email, video conference and/or in person
Core Competencies - Change Agent
- Influencing
- Communication
- Process Management
- Priority Setting
- Peer Relationships
- Critical thinking
- Time Management
- Drive for Results
Tools and Technology Google Suite, Adobe, Salesforce CRM
Physical Functions And Work Environment The physical functions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.
While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.
Note This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any Koya manager authorized to provide instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice.
All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.
Koya Medical, Inc. is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. Contact: info@koyamedical.com
Job Tags
Full time, Contract work, Work experience placement, Remote job,