Patient Advocate Representative

This remote position has duties that overlap with billing support, member communication, claims handling, and account reconciliation — which are similar to billing clerk functions within a healthcare cost‑management organization.

Job Summary

The Patient Advocate Representative supports members, clients, and providers by addressing inquiries related to balance billing and claims, educating callers on the billing process, and ensuring accurate documentation and resolution. Work may include a blend of customer service, medical claim investigation, negotiation, and documentation tasks.

Key Responsibilities

1. Member, Client, and Provider Inquiries:
   Handle incoming phone calls, emails, and texts related to balance billing situations and claims inquiries.
2. Balance Billing Resolution:
   Review and resolve balance billing issues, negotiate with providers when appropriate, and facilitate closure of billing disputes.
3. Education and Guidance:
   Educate members about the billing and claims process, including appeals procedures, timelines, and resolution pathways.
4. Claims Inventory Management:
   Manage a daily running inventory of assigned claims, prioritize work effectively, and maintain clear documentation of actions and outcomes.
5. Documentation and Reporting:
   Ensure all interactions, decisions, and claim resolutions are clearly documented in internal systems and communicated appropriately to stakeholders.
6. Collaboration with Teams:
   Communicate and coordinate across departments to ensure accurate claim resolution and customer satisfaction.
7. Regulatory Compliance:
   Ensure compliance with HIPAA and other privacy requirements due to handling protected health information (PHI).
8. Workload Prioritization:
   Prioritize tasks based on volume and urgency of claims and member inquiries.
9. Continuous Improvement:
   Participate in process improvement efforts to streamline billing dispute resolution and enhance overall efficiency.