Patient Advocate Specialist

Job Description

The Patient Advocate Specialist plays a critical role in identifying, educating, and enrolling eligible hospital patients into the Health Insurance Premium Payment (HIPP) Program. You'll clearly explain program details, gather required documentation, and serve as a compassionate, professional advocate throughout each step of the enrollment process.

This role demands mission‑driven advocacy, proactive problem‑solving, empathetic communication, and resilience—all while balancing compassion with an urgency to ensure patients receive timely support. By facilitating employer‑sponsored health insurance coverage, the Patient Helper Program helps medically complex Medicaid beneficiaries access comprehensive care.

We’re looking for driven individuals with a “can‑do” spirit, unwavering perseverance, and the capacity to support diverse patient populations navigating complex healthcare systems.

• Educate patients and families in a clear, compassionate, and culturally sensitive manner about the HIPP program.
• Assess family dynamics and adapt communication style to effectively meet their needs.
• Obtain necessary authorizations and documentation from patients/families.
• Foster trust with patients while maintaining appropriate professional boundaries.
• Demonstrate cultural competence and empathy when engaging with vulnerable populations.

• Accurately collect all essential data for HIPP applications (e.g., employer information, insurance details).
• Employ proactive problem‑solving to overcome barriers and ensure timely, accurate submissions.
• Collaborate seamlessly with the Patient Financial Assistance (PFA) team to finalize enrollments.
• Consistently deliver against performance metrics such as enrollments completed, case resolution time, and documentation accuracy.

• Clarify how employer‑provided health insurance works in coordination with Medicaid.
• Verify and update ongoing patient eligibility for HIPP to maintain continuity.
• Assist with resolving insurance‑related issues upon request from patients or clients.

• Utilize PFA’s CRM/case management system to manage referrals and patient records.
• Upload, scan, and securely transmit required documentation.
• Record patient interactions meticulously in compliance with privacy and legal standards.
• Efficiently operate Apple tools such as iPads and iPhones for enrollment‑related tasks.

• Represent PFA as the onsite contact at the hospital.
• Establish and maintain collaborative relationships with hospital staff, state agency personnel, and community partners.
• Always uphold the organization’s values with ethical integrity and professionalism.

• High school diploma or GED and completion of formal training in customer service, patient services, healthcare administration, social services, or case management.
• Foundational knowledge of healthcare terminology and insurance processes gained via coursework or certification.
• Ability to pass hospital credentialing, including vaccinations and drug/alcohol screening.

• Associate’s or Bachelor’s degree in Social Work, Healthcare Administration, Public Health, or related field.
• Training in motivational interviewing, trauma‑informed care, or medical billing/coding.
• Continuing education in Medicaid/Medicare eligibility, health equity, or patient advocacy.
• Three‑Five years’ experience in patient‑facing roles within a healthcare setting.
• Full bilingual proficiency in Spanish is strongly preferred.

• Proficiency with CRM or case management systems.
• Knowledge of Medicaid/Medicare eligibility and benefits coordination.
• Ability to interpret medical billing and insurance documents.
• Strong compliance‑based documentation practices.

• Active listening and empathetic communication.
• De‑escalation tactics for emotionally distressed patients.
• Cultural awareness and sensitivity in communication.
• Collaboration with cross‑functional teams, including hospital and internal…