Patient Advocate

Sioux Center Health; Sioux Falls (SD); On-site; USD 29,000 - 37,000; Full time

Benefits offered by this job

PTO available day 1

Retirement matching

Career development

Job summary

Avera Cancer Institute-Sioux Falls is seeking a Patient Advocate to help patients and families navigate medical paperwork, insurance, billing, and program eligibility. You will screen for program eligibility, complete applications, coordinate referrals, obtain authorizations, and work with care teams, insurers, and the business office to resolve coverage gaps with compassion and efficiency.

This role requires 1-3 years in healthcare and insurance verification and an associate's degree or related

Qualifications

• Associate's social work, coding, or a healthcare-related field.
• 1-3 years experience in healthcare and insurance verification.

Responsibilities

• Obtains detailed patient insurance benefit information for all aspects of care, including outpatient services and prescriptions.
• Identifies self-pay patients and helps with coverage applications, including drug assistance.
• Discusses benefits and financial concerns with patients and families and documents in the EMR.
• Obtains insurance authorizations and coordinates level II appeals as needed.
• Assists with copay assistance, compassionate use drug programs, and patient assistance navigation.
• Maintains tracking of authorizations, referrals, and drug assistance; collaborates with care teams.
• Resolves billing issues in coordination with patient, insurer, and business office.

Education

Associate's social work / healthcare field

Job description

Pay Range

The pay range for this position is listed below. Actual pay rate dependent upon experience.

Location:

Avera Cancer Institute-Sioux Falls

Worker Type

Regular

Work Shift

Day Shift (United States of America)

Pay Range

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$20.75 - $27.50

Position Highlights

This position supports our outpatient Hematology, Transplant and Cellular Therapy clinic.

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Responsible to provide assistance to patients and/or families as they navigate through all aspects of their medical paperwork, including insurance, billing, payment and collection process. This position is responsible to screen patients to determine potential for program assistance, complete application with patient and families, and follow up after discharge regarding application and maintain knowledge base of community agencies and resource to facilitate appropriate referrals, including maintaining a thorough understanding of eligibility requirements and current laws governing government programs. A successful advocate will communicate with patients, families, case managers, and providers to assess care plans and corresponding coverage needs and work in a compassionate and tactful manner to help facilitate access to and provide continuity of care. Advocates also work with other members of the care teams, insurers, financial, and administrative personnel.

What You Will Do

• Obtains detailed patient insurance benefit information for all aspects of care, including, but not limited to, outpatient services and prescription drugs. Verifies insurance coverage and other medical benefits and acquire necessary referrals and authorizations.
• Identifies self-pay patients and evaluate coverage opportunities. Assists with completion of all needed applications for coverage, including applications for drug assistance. Provides accurate cost estimate details to patients prior to appointments.
• Discusses benefits and other financial concerns with patients and/or family members during initial referral and during continuation of care. Identifies and effectively communicates financial information to team members, patients, and their families with emphasis on identifying any potential patient out-of-pocket liability. Assists patients with questions concerning insurance, coverage, and other financial issues. Documents in patient record as appropriate.
• Obtains all necessary insurance authorizations. Obtains clinical information as needed from the medical record to answer clinical questions during authorization process. Communicates with care team and pharmacy staff to ensure that all treatments meet medical necessity. Drafts medical necessity authorization request letters to include insurance contact information, patient history, and appropriate scientific literature. Manages both routine and complex insurance authorizations directly. Responsible for the coordination of level II appeals with oversight from the appropriate medical staff.
• Works with patients, their families and team members to help address insurance coverage gaps via alternative funding options including, but not limited to, helps with completing applications for copay assistance, compassionate use drug and/or Avera Patient Assistance. Assists patient and family members in completing work-related documentation including, but not limited to, FMLA, short term disability, long term disability, and work letters.
• Maintains tracking mechanisms for status of authorization requests, referrals, and drug assistance. Regularly assesses updated information regarding insurance data, authorizations, and preferred providers. Tracks free drug assistance to ensure patients maintain coverage when initial enrollment ends.
• Facilitates resolution of patient billing issues which may include appealing denied claims. Works in collaboration with the patient, insurance, and business office.
• Works as a member of a team of Patient Advocates to assist in other departments as needed. Works with multiple disciplines and departments to ensure clear communication and prompt delivery of treatment. Accurately documents all interactions related to advocacy within the EMR.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, Or Work Experience

• Associate's social work, coding, or a healthcare-related field and/or combination of experience and education.
• 1-3 years Experience in healthcare and insurance verification.

Expectations and Standards

• Commitment to the daily application of Avera's mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera's standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [e-mail].