Patient Advocate
: Job Details :

Patient Advocate Services

We are so glad you are interested in joining Sutter Health! Responsible for insurance verification and eligibility, assessment of patient financial requirements, counseling patients on insurance benefits and co-payments, and obtaining preauthorization for all services. Works closely with department staff, physicians and practice staff to facilitate timely start and continuity of services. Works in conjunction with managed care and coding departments to maintain accuracy in clinical and billing information.

Patient Advocate Services

Verifies all insurance and eligibility information is accurate and update insurance record if necessary.

Responsible for obtaining initial and subsequent Preferred provider organization (PPO) authorizations.

Initiates referrals to managed care for Health maintenance organization (HMO) authorizations.

Follows up to ensure medications delivered to patient in a timely manner.

Reviews schedules a minimum of 5 days prior to ensure all treatments are authorized.

Associates authorization with patient's appointment in scheduling system.

Accurately enters all authorization requests into the EPIC system utilizing appropriate codes, treatment types and providers.

Enters supporting data into comment box. Communicates with supervisor or charge nurse, physicians, practice staff when there are issues with authorization.

Oncology

May verify chemotherapy and/or non-chemotherapy are Food and Drug Administration (FDA) or compendia approved for given diagnosis as well as meets insurance specific guidelines.

May perform clinical trial insurance verification and authorization.

Obtains authorization.

May submit authorization with prescription to insurance-specific mail-order specialty pharmacies when appropriate.

Reviews all chemotherapy fee tickets in oncology Electronic Medical Record (EMR) daily or within 48-hours to verify for accuracy of International Classification of Diseases (ICD-9), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) codes and edits as needed.

Follows up in oncology EMR to ensure charges have been posted.

Provides financial counseling for patients prior to start/during treatment regarding insurance benefits and out of pocket expenses.

Provides estimate cost of treatment when requested by patient or staff.

If an ordered treatment is considered off label per guidelines, the position is responsible for creating and explaining financial/ABN waivers to patients prior to receiving treatment.

Assists patients who cannot afford meds, treatment or co-pays to access patient assistance programs.

Continuous Improvement

Follows the commitment to excellence and treats patients, families, visitors and each other with courtesy, dignity, respect and professionalism.

Relationship Management

Assists physicians and patients with appeals process when treatment is denied.

Meets with pharmaceutical drug reps regarding supported patient assistance programs and refers patients to Social Worker for other assistance programs and community services.

Develops relationships with staff within and outside of the department to facilitate the authorization process and resolution of billing issues.

Communicates positively and effectively with physicians, staff and patients.

Works closely with Revenue Cycle to resolve billing issues.

Education

HS Diploma or General Education Diploma (GED)

Typical Experience

2 years of recent relevant experience.

Job Shift

Days

Schedule

Full Time

Shift Hours

8

Days of the Week

Monday - Friday

Weekend Requirements

As Needed

Benefits

Yes

Unions

No

Position Status

Non-Exempt

Weekly Hours

40

Employee Status

Regular

Sutter Health is an Equal Opportunity Employer

EOE/M/F/Disability/Veterans

Pay Range

$38.20 to $47.75 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate's experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.