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Family Health Advocate Jobs
Company | Sharecare |
Address | Atlanta, GA, United States |
Employment type | FULL_TIME |
Salary | |
Category | Wellness and Fitness Services |
Expires | 2023-06-04 |
Posted at | 1 year ago |
:
- Claims adjustments
- Member preferences management
- Referring members to Clinical Advocates (Nurse) for conditions that require clinical care and case management assistance
- Preparing members for scheduled procedures/admissions
- Grievances and appeals submissions
- Is fully versed in and can explain plan benefit design, handles benefit and enrollment issues.
- Drive member's engagement into appropriate programs and offerings.
- Support for spending accounts, pharmacy, and disability.
- Referring members to available 3rd parties for care management and second opinion.
- Provide proactive care guidance for various value-add opportunities:
- Utilization management intake or status
- Interacts with members verbally and in written form to ensure appropriate engagement is achieved.
- Community resource search
- Aid with ordering durable medical equipment (DME)
- Coordinate issue resolution with providers, payers or 3rd parties for:
- Proactive benefits education for procedures
- Answer inquiries from members (via voice and chat) for the following:
- Help with eligibility, benefit education, open enrollment / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, dental, and vision plans
- Complex pharmacy inquiries
- Provider search (PCP, specialty, and facility), focused on healthcare cost and quality, and present premier provider options, including but not limited to medical, dental, and vision plans
- Be an educator on health care related inquiries.
- Guidance on closing care gaps (e.g., No PCP, discussing switching from low quality PCPs to high quality PCPs, reminder for completion of health risk assessment, reminders for exams/tests due)
- Primary duties include but are not limited to:
- Complex spending account inquiries
- Assistance with incentives and rewards
- Understands and communicates the benefit design packages to members as defined by employer.
- Excellent multi-channel communication and problem-solving skills
- Ability to communicate effectively in both voice and chat channels, including critical thinking skills, effective typing, grammar, and spelling skills.
- Physical Therapy Assistant
- Dental Assistant
- Medical Coder
- Pharmacy Technician
- Experience in successful resolution of high level/sensitive customer service issues.
- Medical Assistant
- Nursing Assistant
- Radiology Technician
- High school / GED diploma
- Occupational Therapist Aide
- Health Guide/Advocate/Navigator
- 2-yr associates degree in healthcare/health sciences OR equivalent experience in healthcare, preferably helping members navigate benefits and claims, OR held one or more of the following positions:
- Patient Care Technician (PCT)
- Phlebotomy Technician
- Electrocardiograph (EKG) Technician
- Medical Secretary/Clinic Manager
- Home Health Aide
- Experience in customer service in a healthcare contact center, provider office, or healthcare institution
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