A Resolution Advocate is a patient advocate working with Health Plan members and their health care providers to bring resolution to balance bills that members receive once their Health Plan has made payment to the provider. Balance billings represent the difference between what the Health Plan allows and the provider charges.
One of the most important roles of the Resolution Advocate is the ability to act independently within the scope of their duties/responsibilities and ensure appropriate, timely resolution to all inquiries and issues correctly according to the policies and procedures/step actions.
- Respond to inbound calls from Plan members regarding balance bills, take appropriate action to resolve inquiries, and balance billing tasks in the time frame provided following the policies and procedures/step actions provided.
- Make outbound calls to Plan members regarding balance bills and take appropriate action to resolve.
- Educate members on the correct Health Plan and Plan payment methodology.
- Always assure the confidentiality of calls and documents.
- Document all member/patient contacts/calls in the Patient Advocacy system.
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:
- High School diploma or equivalent.
- A higher degree of education or vocational/technical school in the healthcare industry preferred but not required.
- Minimum of 1-year Healthcare/Insurance Industry experience in patient advocacy, customer service, provider relations, provider contract negotiations, claims or billing/collections preferred.
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.