Compl Claims Patient Advocate

We are a leading provider of software and analytics, network solutions and technology-enabled services that optimize communications, payments and analytics by leveraging our Intelligent Healthcare NetworkTM – the single largest financial and administrative network in the United States healthcare system.

This position is responsible for maintaining the day-to-day workflow of medical claims related to accidents associated with motor vehicle, general liability, and/or workers compensation, so as to determine available medical benefits and pursue payments on behalf of the facility, in accordance with the agreed upon business plan.

• Meet with and interview each patient who presents to the facility Emergency Department (ED) area due to injuries related to accidents associated with motor vehicles, general liability and/or workers compensation, during facility’s designated staffing hours
• Review facility’s report to identify patients who presented to the facility outside CEA’s designated staffing hours or registered outside the Emergency Department (ED) area
• Create a patient file in the system for each patient visit and maintain the file accuracy
• Investigate and confirm any medical coverages related to auto, general liability, and/or worker compensation insurance available to the patient, updating the patient file in the system
• Identify any patient attorney representation and confirm patient representation with the attorney office, recording the attorney information in the patient file in the system
• Communicate per CEA protocol with responsible insurance carriers and attorney offices to secure payment on behalf of the facility, always updating the patient file in the system
• Update patient accounts in any designated facility system(s), in accordance with the agreed upon business plan
• Process work daily for all Patient Counselor groups to ensure a consistent workflow for every patient file, to result in a reimbursement to the facility, in a timely manner
• Communicate any issues/concerns involving patient files or personnel to your direct supervisor

Education / Training:

• High School Diploma or equivalent

Business Experience:

• 2-4 years experience in this field or related area preferred

Specialized Knowledge / Skills:

• Ability to work well in an independent setting with minimal supervision
• Ability to work collaboratively within a team
• Strong customer service skills
• Detail oriented
• Strong verbal and written communication skills
• General knowledge of Microsoft Office

Working Conditions:

• Environment – Fast-paced hospital and/or office environment.
• Physical Requirements – Sitting, standing, walking, and using key board.
• Work requirements may include days, evenings, weekends and holidays as required