Patient Advocate, Health Insurance Specialist

Title: Patient Advocate, Health Insurance Specialist     

Salary / Salary Range: $50k - $55k  

Employment Status:  Full-time  

Department: Clinical Services 

Supervisor: Assistant Director of Patient Advocacy  

Office: Clinic (3100 Red River, Austin, TX 78705) 

Full time, exempt 

Target start date: November 8, 2024 

About the Organization:  

ASHwell is a sexual health and wellness center established in Austin, TX in the late 1980s. We are passionately committed to diversity, equity, and belonging. We strive to provide a safe discrimination-free space for all and predominantly serve LGBTQIA+ and BIPOC communities. Our approach to sexual health and wellness is rooted in being proudly sex and kink positive, pro-sex worker, pro-harm reduction and anti-stigma. We are a growing organization looking for values-aligned, pro-sexual health and wellness people to join our team! 

Position Overview: 

The Patient Advocate, Health Insurance Specialist works closely with patient-clients to help individuals enroll in, understand, and navigate the complexities of health insurance plans. The Patient Advocate is a dedicated individual who will help patient-clients understand their insurance benefits and handle any billing concerns, to improve the patient’s overall experience. Most significantly, the Patient Advocate will assist uninsured patient-clients in obtaining health insurance by guiding them through the complex application process and ensuring that they can receive the necessary care. 

Core Responsibilities 

• ACA Enrollment - 30% 
• Evaluate patient-clients' eligibility for various health insurance plans and public assistance programs, ensuring they meet the criteria for enrollment. 
• Guide patient-clients through the application process for health insurance, helping them complete forms accurately and gather necessary documentation. 
• Provide detailed information on different health insurance options, including coverage benefits, costs, and provider networks, to help patient-clients make informed decisions. 
• Track the progress of submitted applications, communicate with insurance companies to resolve any issues, and ensure that patient-clients are enrolled in a timely manner. 

• Patient Assistance - 20% 
• Clarify details about patient-clients' insurance coverage, including what services are covered, out-of-pocket costs, copays, and deductibles, ensuring patient-clients understand their benefits and responsibilities. 
• Assist patient-clients in understanding their medical bills, addressing any discrepancies or errors, and providing explanations for charges and insurance adjustments. 
• Help patient-clients apply for financial assistance programs, such as sliding scale fees, premium assistance, charity care, or pharmaceutical assistance programs, to reduce their financial burden. 
• Assist patient-clients in appealing denied insurance claims, gathering necessary documentation, and communicating with insurance companies to resolve issues and obtain coverage. 

• Insurance Verification – 20% 
• Confirm patient-clients' insurance coverage details, including plan type, coverage limits, copays, deductibles, and any exclusions, ensuring the information is accurate and up-to-date. 
• Validate patient-clients' eligibility for specific services or treatments under their health insurance plan before appointments or procedures to avoid coverage issues and unexpected costs. 

• Pre-Authorization and Referrals – 20% 
• Prepare and submit requests for pre-authorization to health insurance companies for specific treatments, procedures, or medications, ensuring all required documentation and information is included. 
• Monitor the status of submitted pre-authorization requests, follow up with health insurance companies to expedite the process, and address any issues or additional requirements promptly. 
• Liaise with doctors, nurses, and other healthcare providers to gather necessary medical information and documentation needed for pre-authorization and referral requests. 
• Notify patient-clients about the status of their pre-authorization and referral requests, providing them with relevant information and instructions regarding their upcoming treatments or specialist visits. 

• Baseline – 10% 
• Participate in all required staff meetings and retreats. 
• Maintain up-to-date calendar and work plan. 
• Utilize org – wide systems and protocols for all agency business. 
• Offer at least 24 hours’ notice for internal meeting cancellations/rescheduling. 
• Maintain chain of command for internal communications.  

About You 

The ASHwell Patient Advocate, Health Insurance Specialist is a detail-oriented initiative taker who thrives in a culturally sex positive and kink loving space. The Health Insurance Specialist is a detail-oriented professional with extensive knowledge of health insurance policies and healthcare regulations. They possess exceptional communication skills, enabling them to effectively interact with patient-clients, healthcare providers, and health insurance companies. With strong problem-solving abilities, they excel at resolving issues related to claims, coverage, and pre-authorizations. Their organizational skills ensure efficient management of multiple tasks and accurate record-keeping. Additionally, experience with financial counseling and multilingual abilities are highly valued, enhancing their capacity to support a diverse patient-client population. They can connect their role and its responsibilities to the bigger picture of ASHwell’s mission.  

Required Qualifications:  

• Aligned with ASHwell’s values. 
• Empathetic and patient-focused approach to ensure a positive experience for patient-clients navigating insurance and healthcare processes. 
• In-depth understanding of health insurance plans, coverage policies, and claims processing. 
• High accuracy in verifying health insurance information, submitting claims, and processing pre-authorizations. 
• Strong communication and written skills, and a demonstrated ability to work effectively with diverse staff, patient-clients, healthcare providers, insurance companies, and pharmacies. 
• Ability to identify and address challenges related to health insurance coverage, billing discrepancies, and medication deliveries. 
• Strong independent problem-solving skills, with the capability to contribute to project and program designs under supervision. 
• Excellent organizational abilities to manage tasks and responsibilities efficiently. 
• Lives in Austin, TX or within the greater Austin Metro Area or willing to relocate. 
• Baseline understanding of gender pronouns, pro sex culture and HIV de-stigmatization and/or willingness to learn. 
• Computer proficiency including strong skills in web-based applications and MS Office.  
• Commitment to providing excellent patient-client care and to continuous quality improvement. 

Preferred Qualifications:  

• Bachelor’s degree related to a human services field, such as social work, psychology, counseling or public health. Two-year degrees with licensure and/or four years of relevant work experience will be considered in lieu of a bachelor's degree. 
• 2+ year experience in health insurance enrollment or navigation, ACA policy, and medication access.   
• Fluent in the language and culture of the public sexual health sector Experience working or volunteering in HIV/STI prevention or other community health programs. 
• Experience working with LGBTQI+ and other underserved populations. 
• Familiarity with medical terms and codes (e.g., ICD-10, CPT) to streamline communication with healthcare providers and health insurance companies. 
• Ability to analyze data and identify trends or issues in insurance claims and coverage, helping to improve processes and patient-client outcomes. 
• Bi-lingual English and Spanish speaking, including medical interpretation. 
• Experience working with EHRs. 
• Experience conducting Motivational Interviewing.   

Our Hiring Process 

The start date for this position is November 8, 2024. Applications are due no later than midnight CT on September 6, 2024. We are committed to offering the support, time, and resources necessary to on-board and orient to the role.   

Timeline 

• Applications Due September 6, 2024  
• Invitations to Interview: September 17-20 
• Round 1 Interviews: week of September 23-26  
• Round 2 interviews: September 30-October 3 
• Final interviews: October 7-10  
• Goal date for offers: October 14-18 
• Position start date November 8, 2024  

ASHwell uses a cohort onboarding model. The start date is a group orientation day for hires across the organization. 

EOE STATEMENT 

As an Affirmative Action and Equal Opportunity Employer, ASHWell is committed to creating an inclusive environment that values the diversity of its employees and does not discriminate against any employee or candidate. Women, minorities, veterans, people from the LGBTQ2SAI+ communities and people with disabilities are strongly encouraged to apply to join our teams. Reasonable accommodation to access job openings or to apply for a job is available.