Customer Service – Resolution Advocate II

Payer Compass is actively seeking a Customer Service - Resolution Advocate II. This is a remote (work from home) position that is based out of our St. Petersburg, Florida office.

Department: Member & Provider Advocacy Operations Location: Plano, TX or Remote

Basic Functions:

The Advocacy Operations Resolution Advocate, II is a vital role in ensuring service excellence to Payer Compass clients and their members. The Resolution Advocate, II’s primary responsibility is to investigate and resolve balance billing issues for members who have received health care services and Health Plan benefits have been administered. This position requires the ability to act independently within the scope of assigned duties and responsibilities and within established policies and guidelines. A key factor in the success of the Resolution Advocate, II role is the ability to educate members on Health Plan reimbursement methodology, and patient liability vs. balance billing when required. All job functions will be completed using approved policies and procedures, and system design and technical documentation for all Payer Compass systems and product offerings.

Payer Compass operates within multiple proprietary systems and multiple product offerings. This includes Avedon, Visium™, Compass Connect, and Innovate360. The Advocacy Operations Auditor will support systems design, test implementations, system migration, and new product offerings as needed.

  • Research and respond to inquiries (including calls, faxes, or self-service submissions) from Health Plan members and providers regarding balance bills.
  • Independently determine the appropriate action to resolve inquiries and balance billing tasks within established service level indicators in adherence to policies, procedures, protocol, and workflow.
  • Make outbound calls, respond to email or self-service submissions to Plan members regarding balance bills and take appropriate action to resolve.
  • Educate members on Health Plan and Plan payment methodology and member liability.
  • Generate correspondence ensuring it is free of spelling and grammatical errors.
  • Comply with HIPAA regulations and ensure confidentiality of calls, documents, and other sensitive information.
  • Properly document activity and calls in the appropriate Payer Compass system.
  • Serve as a liaison with Third Party Administration claims.
  • Maintain established performance standards (production, quality, and attendance).

Other Responsibilities as Assigned:

  • Special projects as assigned by the leadership team.
  • Miscellaneous office duties as assigned.
  • Back-up to other positions as assigned by the leadership team.

Education and Work Experience:

  • A minimum of 2 years of experience working in the Healthcare/Insurance Industry experience in patient advocacy, customer service, provider relations, or claims, or one year of satisfactory performance in a similar or equivalent Payer Compass role
  • A High School diploma or equivalent is required.  Associate or Bachelor’s Degree preferred, but not required.
  • Minimum of 2 years of experience working in production and fast-paced environment.

Knowledge, Skills and Key Competencies:

  • Self-driven, professional willing to take ownership of the role and the projects within a team environment.
  • Ability to be efficient with completing tasks in a timely manner and prioritizing projects according to urgency while meeting all goals and deadlines.
  • Strong attention to detail, time management and decision-making skills.
  • Professional demeanor
  • Demonstrated job stability
  • Exceptional customer service skills, both verbal and written.
  • MS Office proficiency, especially Excel
  • Office Equipment, faxes, copiers

Protects and maintains patient and institutional information in a confidential manner and in a secured environment. Ensures data access limitations through the use of password protection, read-only access, and other measures that protect the data from unauthorized or accidental access.

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