Patient Case Advocate

Houston, TX | Contractor

Post Date: 11/07/2017 Job ID: JGX4736HL9SDPBXB7KH Industry: Health Care, Admin - Clerical
Pulse Staffing has an exciting immediate 4-6 month contract available for a patient case advocate. The patient case advocate will provide effective collaboration as the liaison between the reimbursement team, surgeon's office, and patients to coordinate attempts to secure coverage for their medical procedures. This position will be remote - working from home.
Job duties include:
  • Provide high quality customer service and frequent interaction with surgeon offices and patients regarding case status and outcome of pre-authorizations and appeals in company’ s case management program
  • Support the company’ s strategic reimbursement plans, e.G., case management and reimbursement policy efforts 
  • Communicate with patient’ s insurance coverage to determine process for pre-authorizations/pre-determinations through all levels of appeals; manage the insurance authorization process, including the verification of benefits, prior authorization process, and the appeal process
  • Coordinate securing patient’ s supporting medical documentation, letters of medical necessity and appeal letter signatures from referring surgeons
  • Guide patients through the insurance coverage support process; communicate regularly with patients and their families about case status and next steps in the appeal process, and address patient concerns.
  • Track, monitor and report the outcomes of reimbursement initiatives (e.G., appeal outcomes from peer-to-peer reviews, external [independent] medical review, trends observed from the various initiatives, etc.) in assigned territory
  • Maintain accurate and complete documentation of all inquiries
  • Other duties as assigned.


  • Associates degree in medical billing, coding or health information management preferred (applicable work experience can substitute for degree)
  • Five plus years’ experience with health insurance, benefits investigations, and reimbursement, along with billing and coding
  • Experience with prior authorizations and reimbursement
  • Excellent written and verbal communication skills
  • Excellent customer service skills with a focus on assisting patients in a healthcare environment
  • Strong attention to detail, time management and organizational skills
  • Possess a demonstrated ability to communicate effectively and work well with others throughout the Company
  • Demonstrates a positive 'can do' attitude
  • Possess effective problem solving skills


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