[Hiring] Personal Health Advocate @LanguageLine Solutions

Role Description

At Health Advocate, we are committed to providing our customers with services that improve the health, well-being and productivity of their employees. The Personal Health Advocates are a dedicated team of Registered Nurses who assist our members in navigating the healthcare system by facilitating access to healthcare providers, health and benefit information, health services and resources and entitled benefits coverage.

Essential Job Functions

• Receive calls from members regarding various healthcare issues (e.g., infertility, disease, medication) and determine best course of action to assist members while adhering to established policies, procedures, and key performance indicators (KPIs).
• Build relationships with members to collaborate and develop plans of action, taking responsibility for members’ case records.
• Assist and educate members in understanding their medical conditions, associated health testing, test result interpretation, and health options available to them.
• Provide members choices in medical care providers and services based on their clinical needs, geographic locations, and available benefit offerings.
• Research providers through credentialing, education checks, and affiliations with notable medical centers within the member’s plan.
• Facilitate communication among members, treating physicians, and insurance carriers.
• Assist with scheduling and re-scheduling health appointments, facilitating record transfers, and resolving various problems as applicable.
• Document cases in the department’s case management system using approved processes and procedures.
• Escalate cases appropriately and on a timely basis to supervisor or internal resources for review.
• Keep up-to-date on patient care procedures including diagnosis, pre-certification, prior authorization, and denials.
• Continuously stay updated on various health issues and medical procedures.
• Intercede for the member to obtain an earlier appointment.
• Help members obtain prescriptions and with pre-service fee negotiations.
• Place outbound follow-up calls for unresolved issues.
• Respond to member cases in delegate box, answers, and after hours calls.
• Mentor new team members.

Team Interfaces/Customer Service

• Establish and maintain a professional relationship with internal/external customers, team members, and department contacts.
• Cooperate with team members to meet goals or complete tasks.
• Provide customer service that exceeds customer expectations.
• Treat all internal/external customers, team members, and department contacts with dignity/respect.
• Escalate workflow and communication issues to supervisor.

Qualifications

• BSN or RN degree from an accredited college or university required.
• Minimum three to five years clinical and/or medical management experience.
• Active and unrestricted State or Multi-State RN License.
• Understanding of medical terminology to assist in locating appropriate care options.
• Strong communication skills and phone etiquette.
• Strong ability to explain complex issues to employees/retirees.
• Highly effective listening skills.
• Strong problem solving/issues resolution skills.
• Excellent customer service and customer resolution skills.
• Organizational and administrative skills.
• Experience with Microsoft Word and Excel.
• Ability to work in a team environment.

Requirements

• This position is remote; employee must have a dedicated HIPAA compliant workspace and access to internet and router.
• The nature of the work is sedentary; incumbent will be sitting most of the time.
• Essential physical functions include fingering, grasping, pulling hand over hand, and repetitive motions to utilize general computer software/hardware.
• Essential mental functions include concentrating on tasks, reading information, and verbal/written communication continuously throughout the workday.

Related Duties as Assigned

• The job description documents the general nature and level of work but is not intended to be a comprehensive list of all activities, duties, and responsibilities required of job incumbents.
• Job incumbents may be asked to perform other duties as required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.