What are the responsibilities and job description for the Patient Advocate position at California Retina Consultants?
Patient Advocate
Job Summary
The Patient Advocate is responsible for duties pertaining to all aspects of patient payments and billing inquiries. Including enrollment and re-enrollment into patient assistance programs (PAPs), financial hardship programs, and patient payment plans. This individual will work cohesively with our billing partners to see that patient assistance program claims are submitted in a timely manner, and to ensure prompt payment of these claims, from the various PAP vendors. The Patient Financial Services Coordinator also provides SME support to our clinic staff, to address billing inquires related to patient assistance programs and self-pay encounters.
This is a Remote position; however, all candidates considered for this position must currently reside within Central California.
Duties / Responsibilities:
- Prepares and submits clean claims to various insurance companies either electronically or by paper.
- Contacts Insurance companies and financial assistance programs regarding unpaid claims via rebill, appeals, or phone.
- Accepts in-coming phone calls for patient inquiries.
- Answers questions from patients, clerical staff and insurance companies via phone, email, and messaging portals.
- Identifies and resolves patient billing complaints.
- Prepares, reviews and sends patient statements as needed.
- Mails appropriate patient contact letters to resolve outstanding claims.
- Evaluates patient’s financial status and establishes budget payment plans.
- Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
- Utilizes Practice Management software and completes assigned AR and Patient tasking.
- Participates in educational activities and attends monthly staff meetings.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Responding to all PFS inquiries via email inbox, phone calls to billing and PAP line, MS Teams messages, and via individual tasks in NextGen
- Maintaining NextGen Patient Assistance Program tasks and communicating with billing staff regarding enrollments, re-enrollments, etc.
- Reviewing drug balance report and enrolling patients into Patient Assistant programs as applicable, based on outstanding balances
- Manage all first time and re-enrollment of patients into Patient Assistance Programs
- Responsible for claims submissions to various programs via fax, mail, and online portal.
- Responsible for payment posting from various assistance programs.
- Submitting appeals as necessary.
- Training Front Desk and Billing staff on PX Connect and drug portals.
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Assists PFS Supervisor as gatekeeper for all portal access:
- New hires
- Disabling access to PAP portals upon notification of termination/resignation
- Password resets
- Establishes and maintains professional relationships with various pharmaceutical vendors/reps, to stay current on medication and PAP happenings, protocol, and pertinent billing guidelines.
- Performs other duties as assigned.
About the Candidate
Preferred Skills / Abilities:
- NextGen, MDI EMR, and basic ICD-10 codes
- Excellent verbal and written communication skills
- Ability to multitask
- Ability to work independently and as a team
- Proactive in their work
Education and Experience:
- High school diploma or equivalent
- Bachelor's degree or relevant work experience
Who We Are
California Retina Consultants (CRC) is one of the largest, most highly respected retina-only ophthalmology groups in the United States and is committed to providing state-of-the-art treatments. All California Retina Consultant physicians are board certified/eligible by the American Board of Ophthalmology and specialize exclusively in diseases and surgery of the retina, vitreous, and macula. Our physicians have studied at the most prestigious medical center and universities and have each achieved numerous honors and awards. In addition, CRC participates in national cutting edge clinical and investigator-sponsored trials, participating in hundreds since it's founding.
Benefits
CRC offers the following competitive benefits for full-time eligible employees after the introductory period:
- Medical Insurance Plans
- Vision Insurance Plan
- Dental Insurance Plan
- 401K Contribution
- Life Insurance
- Sick, Vacation, and Holiday Pay
- Certification Opportunities
Equal Opportunity Employer
California Retina Consultants is proud to be an Equal Employment Opportunity and an Affirmative Action Employer. We are committed to creating an inclusive work environment that celebrates diversity.
(All offers are contingent upon satisfactory background check and pre-employment drug screen.)