Patient Advocate

Gonzaba Medical Group; San Antonio (TX); On-site; USD 36,000 - 48,000; Full time

Job summary

Gonzaba Medical Group in San Antonio, TX is seeking a Patient Experience Advocate to support Medicare Advantage patients and other GMG clients with service needs. You will assist over the phone and in person, schedule visits, verify benefits, and help patients navigate plans.

Ideal candidates have at least 5 years in healthcare customer service, 3 years in patient relations, and prefer experience with Medicare Advantage. Bilingual English/Spanish is preferred to serve a diverse patient base.

Qualifications

• Minimum high school diploma or equivalent.
• Minimum 5 years' experience in a healthcare setting.
• Three years of customer relations experience.
• Experience with Medicare Advantage plans preferred.
• Bilingual in English/Spanish preferred.

Responsibilities

• Provide customer service related to Medicare Advantage patients and other GMG patients.
• Make outbound welcome calls to new Medicare Advantage patients monthly.
• Schedule new patients for intake and initial PCP visit.
• Match prospective patients with a GMG provider and Medical Center.
• Schedule, cancel and reschedule daily appointments using the Athena system.
• Assist patients with access to Medicare Advantage benefits and formulary transitions.
• Answer calls to the Patient Advocate queue and assist with service issues.
• Assist patients in the office with customer service and plan questions.
• Verify insurance eligibility for Medicare Advantage patients.
• Maintain patient charts in practice management systems.

Skills

Customer service

Bilingual English/Spanish

Communication

Education

High school diploma

Job description

Job Details

Job Location: 933 Plaza MSO - Pleasanton Rd. - San Antonio, TX 78214

Position Type: Full Time

Job Category: Patient Experience

General Summary

This position is primarily responsible for helping our Managed Care (MC) patients with complaints, service issues, and optimizing their MC plan benefits. This position helps patients over the phone and in person. The primary purpose is to attract and retain patients to the practice through excellent customer service.

Supervisory Responsibilities

This job has no supervisory responsibilities.

General Requirements

All duties performed will be done accurately and in a timely manner.

• Assumes responsibility for maintaining health care professional competencies according to Gonzaba Medical Group policy.


• Ensures customer service is always maintained at the highest level.


• Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.


• Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.


• Bilingual in English/Spanish is preferred.


• Participates in educational programs as needed.


• Works closely with other GMG departments and teams to ensure our patients requests are handled timely and accurately.


• Other duties as assigned.

Essential Job Responsibilities

• This position is primarily responsible for customer service related to specific Medicare Advantage patients, though helps any GMG patient with service needs/issues.


• Makes outbound welcome calls to all new Medicare Advantage patients monthly to educate patients regarding their Medicare Advantage health plan benefits, orient patients on GMG services and Patient Advocate role.


• Schedules new patients for Intake and initial PCP visit from new enrollment lists.


• Matches prospective patients with a GMG provider and Medical Center to meet their individual needs.


• Schedules, cancels and reschedules daily appointments for all GMG physicians and mid-level providers using the Athena system.


• Compares current specialists and prescription medications to network providers and formulary; help patient transition to plan specialists and formulary meds.


• Assist and guide patients on how to access their Medicare Advantage value added benefits.


• Answers all incoming calls to the Patient Advocate queue to assist patients with customer service, health plan and care related issues.


• Assists patients in the office with customer service, health plan and service issues.


• Processes prescription refill requests per GMG guidelines.


• Assists patients with information about community resources available to support their healthcare/social needs.


• Process registration of all new patients includes obtaining all necessary data, verification of insurance coverage and creation of the patient charts.


• Assist patients prepare insurance, disability and claim forms that require PCP signatures.


• Verify insurance eligibility for Medicare Advantage patients on multiple insurance platforms.


• Accurately documents pertinent patient information in clinic practice management systems.


• Assists providers and staff with questions regarding Medicare Advantage plans and benefits.


• Travel to and from smaller clinics by schedule to assist patients either scheduled or walk-in.


• Manage an in-house prescription copay assistance program.


• Schedule transportation for patients medical appointments through multiple insurance benefit providers and/or various types of public transportation.


• Assist Medicare Advantage patients with changing their PCP selection at the insurance level by phone or paper form.


• This position will require driving a company vehicle or a personal vehicle; therefore, employees must successfully complete a motor vehicle history check, possess, and maintain a current valid Texas Driver License, and proof of current insurance to be subject for mileage reimbursement.


• Maintains strictest member and company confidentiality.

Work Environment

Depending upon the area assigned, may be 100% clinical setting or office setting in a clinical environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Mental / Physical Requirements

Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 10 lbs. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.

Additional Information

Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.

Other Duties As Assigned

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Reasonable accommodation may be made to enable otherwise qualified individuals with disabilities to perform the essential functions of the job.

Qualifications

• Education and Training: Minimum high school diploma or equivalent required.


• Experience: Minimum 5 years' experience in a healthcare setting preferred. Three years of customer relations experience preferred. Experience with Medicare Advantage plans or referrals, familiar with a variety of the field’s concepts, practices, and procedures preferred.


• Other Requirements: Computer Skills: Excellent computer skills, knowledge of Word Processing software, database software, spreadsheet and Internet software.