PCNA

We’re unique.  You should be, too.

We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Patient Continuity & Needs Advocate is responsible for helping to cultivate positive patient experience and drive long-term member retention. The incumbent in this role works collaboratively with Membership Growth Consultants (MGCs) and Center Dyads to execute targeted activities to retain membership.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Supports Medicaid enrollment; collects demographic documentation and financial data and initiates follow-up procedures when necessary.
• Identifies and shares, with patient and/or family member(s), opportunities to maximize medical benefits and, when necessary, arranges follow-up appointments to ensure appropriate guidance to health services and application timelines.
• Utilizes an Electronic Medical Records (EMR) system to gather and store patient information, respond to questions on behalf of the patient and appropriately and timely document patient issues and resolutions. Maintains assigned work queue of patient accounts.
• Completes relevant patient documentation in compliance with all regulatory agencies, including HIPAA.
• Finds creative and compliant ways to engage with our patients and advance our need to have patients call us first.
• Engages with all patients in the lobby, acting as a lobby ambassador, to identify opportunities for referrals, patient ambassadors, and service recovery.
• Responsible for escalating service recovery issues to Center Dyad to ensure timely resolution.
• Leverages Medallia and other patient experience tools to proactively identify members for early service recovery intervention.
• Establishes strong relationships with brokers and agents that have ties with center.
• Leverages MEDALs and other tools to intervene on future disenrollment and disenrolled membership in partnership with Center Dyad.
• Compliantly connects future disenrolls/disenrolled members with agent of record of broker/agent of the day and notifies MGC of record or MGC of the day to reenroll members.
• Identifies and reports on actionable disenrollment and patient engagement trends to inform member retention strategy in collaboration with Center Dyad.
• Performs other duties as assigned and modified at manager’s discretion.

KNOWLEDGE, SKILLS AND ABILITIES:

• Fundamental knowledge and understanding of local, state and federal healthcare benefit services and plans
• Ability to maintain exceptional customer service relationships with healthcare services agencies, patients, providers and peers
• Dependable and time conscience
• Flexibility, agility, self-starter, comfortable with frequent changes and innovations
• Competent level business acuity
• In-Depth knowledge and understanding of general/core job-related functions, practices, processes, procedures, techniques and methods
• Expert knowledge of member attribution, eligibility and disenrollment process
• Proven track record establishing and maintaining relationships with seniors
• Demonstrated skill in customer service and service recovery
• Knowledge of and experience in working with insurance brokers or agents preferred
• Detail-oriented and proficiency in Salesforce
• Excellent written and verbal communication skills
• Positive attitude and the ability to build trust with internal and external partners
• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software
• Spoken and written fluency in English

EDUCATION AND EXPERIENCE CRITERIA:

• High School diploma OR GED equivalent required.
• BA/BS degree preferred OR additional experience above the minimum may be considered in lieu of the required education on a year-for-year basis
• A minimum of 3 years work experience required; working with seniors a plus as is a general understanding of Medicare Advantage