Patient Advocate

The Patient Advocate is responsible for duties pertaining to all aspects of patient payments and billing inquiries. Including enrollment and re-enrollment into patient assistance programs (PAPs), financial hardship programs, and patient payment plans. This individual will work cohesively with our billing partners to see that patient assistance program claims are submitted in a timely manner, and to ensure prompt payment of these claims, from the various PAP vendors.

The Patient Financial Services Coordinator also provides SME support to our clinic staff, to address billing inquires related to patient assistance programs and self-pay encounters.

This is a Remote position; however, all candidates considered for this position must currently reside within Central California.

• Prepares and submits clean claims to various insurance companies either electronically or by paper.
• Contacts insurance companies and financial assistance programs regarding unpaid claims via rebill, appeals, or phone.
• Accepts in‑coming phone calls for patient inquiries.
• Answers questions from patients, clerical staff and insurance companies via phone, email, and messaging portals.
• Identifies and resolves patient billing complaints.
• Prepares, reviews and sends patient statements as needed.
• Mails appropriate patient contact letters to resolve outstanding claims.
• Evaluates patients' financial status and establishes budget payment plans.
• Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third‑party payers.
• Utilizes Practice Management software and completes assigned AR and Patient tasking.
• Participates in educational activities and attends monthly staff meetings.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Responds to all PFS inquiries via email inbox, phone calls to billing and PAP line, MS Teams messages, and via individual tasks in Next Gen.
• Maintains Next Gen Patient Assistance Program tasks and communicates with billing staff regarding enrollments, re‑enrollments, etc.
• Reviews drug balance report and enrolls patients into Patient Assistant programs as applicable, based on outstanding balances.
• Manages all first‑time and re‑enrollment of patients into Patient Assistance Programs.
• Responsible for claims submissions to various programs via fax, mail, and online portal.
• Responsible for payment posting from various assistance programs.
• Submits appeals as necessary.
• Trains Front Desk and Billing staff on PX Connect and drug portals.
• Assists PFS Supervisor as gatekeeper for all portal access:
  • New hires
  • Disabling access to PAP portals upon notification of termination/resignation
  • Password resets
  • Establishes and maintains professional relationships with various pharmaceutical vendors/reps, to stay current on medication and PAP happenings, protocol, and pertinent billing guidelines.
• Performs other duties as assigned.