Job Description
General Summary: This position is primarily responsible for helping our Managed Care (MC) patients with complaints, service issues, and optimizing their MC plan benefits. This position helps patients over the phone and in person. The primary purpose is to attract and retain patients to the practice through excellent customer service. Supervisory Responsibilities: This job has no supervisory responsibilities.
General Requirements: All duties performed will be done accurately and in a timely manner.
- Assumes responsibility for maintaining health care professional competencies according to Gonzaba Medical Group policy.
- Ensures customer service is always maintained at the highest level.
- Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.
- Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
- Bilingual in English/Spanish is preferred.
- Participates in educational programs as needed.
- Works closely with other GMG departments and teams to ensure our patients requests are handled timely and accurately.
- Other duties as assigned.
Essential Job Responsibilities - This position is primarily responsible for customer service related to specific Medicare Advantage patients, though helps any GMG patient with service needs/issues.
- Makes outbound welcome calls to all new Medicare Advantage patients monthly to educate patients regarding their Medicare Advantage health plan benefits, orient patients on GMG services and Patient Advocate role.
- Schedules new patients for Intake and initial PCP visit from new enrollment lists.
- Matches prospective patients with a GMG provider and Medical Center to meet their individual needs.
- Schedules, cancels and reschedules daily appointments for all GMG physicians and mid-level providers using the Athena system.
- Compares current specialists and prescription medications to network providers and formulary; help patient transition to plan specialists and formulary meds.
- Assist and guide patients on how to access their Medicare Advantage value added benefits.
- Answers all incoming calls to the Patient Advocate queue to assist patients with customer service, health plan and care related issues.
- Assists patients in the office with customer service, health plan and service issues.
- Processes prescription refill requests per GMG guidelines.
- Assists patients with information about community resources available to support their healthcare/social needs.
- Process registration of all new patients includes obtaining all necessary data, verification of insurance coverage and creation of the patient charts.
- Assist patients prepare insurance, disability and claim forms that require PCP signatures.
- Verify insurance eligibility for Medicare Advantage patients on multiple insurance platforms.
- Accurately documents pertinent patient information in clinic practice management systems.
- Assists providers and staff with questions regarding Medicare Advantage plans and benefits.
- Travel to and from smaller clinics by schedule to assist patients either scheduled or walk-in.
- Manage an in-house prescription copay assistance program.
- Schedule transportation for patients medical appointments through multiple insurance benefit providers and/or various types of public transportation.
- Assist Medicare Advantage patients with changing their PCP selection at the insurance level by phone or paper form.
- This position will require driving a company vehicle or a personal vehicle; therefore, employees must successfully complete a motor vehicle history check, possess, and maintain a current valid Texas Driver License, and proof of current insurance to be subject for mileage reimbursement.
- Maintains strictest member and company confidentiality.
Work Environment: Depending upon the area assigned, may be 100% clinical setting or office setting in a clinical environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.
Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 10 lbs. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.
Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.
Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Reasonable accommodation may be made to enable otherwise qualified individuals with disabilities to perform the essential functions of the job.
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