Patient Care Advocate

About This Role

Providing support to members and healthcare providers to improve the overall patient experience is the core of this role. This involves removing barriers to care, closing care gaps, and interacting directly with members and providers in large IPA and group practices. The advocate collaborates with providers to improve HEDIS measures and educates on HEDIS measures and coding.

Responsibilities

• Work with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction
• Collaborate with providers in the field to improve HEDIS measures and provide education for HEDIS measures and coding
• Support the implementation of quality improvement interventions and audits in relation to plan providers
• Assist in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS
• Conduct telephonic outreach, while embedded in the providers' offices, to members identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements
• Provide education to members regarding care gaps when in the providers' office for medical appointments
• Schedule doctor appointments on behalf of the practitioner and assist members with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available
• Maintain confidentiality of business and protected health information
• Act as a liaison and member advocate between the member/family, physician and facilities/agencies
• Act as the face of WellCare in the provider community with the provider and office staff where services are embedded
• Advise and educate provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements
• Assess provider performance data to identify and strategize opportunities for provider improvement
• Collaborate with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters)
• Schedule doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider’s office
• Conduct face-to-face education with the member and their family, in the provider’s office, about care gaps identified and barriers to care
• Conduct telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements
• Arrange transportation and follow-up appointments for members as needed
• Document all actions taken regarding contact related to member
• Interact with other departments including customer service to resolve member issues