Patient Advocate

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This position is primarily responsible for helping our Managed Care (MC) patients with complaints, service issues, and optimizing their MC plan benefits. The role assists patients over the phone and in person, and its primary purpose is to attract and retain patients to the practice through excellent customer service.

This job has no supervisory responsibilities.

• Assumes responsibility for maintaining health care professional competencies according to Gonzaba Medical Group policy.
• Ensures customer service is always maintained at the highest level.
• Exercises tact and courtesy when dealing with patients, visitors, providers, and co‑workers.
• Adheres to customer service expectations for in‑person and virtual communication (telephone or telehealth applications).
• Bilingual in English/Spanish is preferred.
• Participates in educational programs as needed.
• Works closely with other GMG departments and teams to ensure patient requests are handled timely and accurately.
• Other duties as assigned.

• This position is primarily responsible for customer service related to specific Medicare Advantage patients, though it helps any GMG patient with service needs/issues.
• Makes outbound welcome calls to all new Medicare Advantage patients monthly to educate patients regarding their Medicare Advantage health plan benefits, orient patients on GMG services and Patient Advocate role.
• Schedules new patients for Intake and initial PCP visit from new enrollment lists.
• Matches prospective patients with a GMG provider and Medical Center to meet their individual needs.
• Schedules, cancels and reschedules daily appointments for all GMG physicians and mid‑level providers using the Athena system.
• Compares current specialists and prescription medications to network providers and formulary; helps patient transition to plan specialists and formulary meds.
• Assists and guides patients on how to access their Medicare Advantage value‑added benefits.
• Answers all incoming calls to the Patient Advocate queue to assist patients with customer service, health plan and care related issues.
• Assists patients in the office with customer service, health plan and service issues.
• Processes prescription refill requests per GMG guidelines.
• Assists patients with information about community resources available to support their healthcare/social needs.
• Processes registration of all new patients includes obtaining all necessary data, verification of insurance coverage and creation of the patient charts.
• Assists patients prepare insurance, disability and claim forms that require PCP signatures.
• Verifies insurance eligibility for Medicare Advantage patients on multiple insurance platforms.
• Accurately documents pertinent patient information in clinic practice management systems.
• Assists providers and staff with questions regarding Medicare Advantage plans and benefits.
• Travels to and from smaller clinics by schedule to assist patients either scheduled or walk‑in.
• Manages an in‑house prescription copay assistance program.
• Schedules transportation for patients medical appointments through multiple insurance benefit providers and/or various types of public transportation.
• Assists Medicare Advantage patients with changing their PCP selection at the insurance level by phone or paper form.
• This position will require driving a company vehicle or a personal vehicle; therefore, employees must successfully complete a motor vehicle history check, possess and maintain a current valid Texas Driver License, and provide proof of current insurance to be subject for mileage reimbursement.
• Maintains strictest member and company confidentiality.

Depending upon the area assigned, may be 100% clinical setting or office setting in a clinical environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching,…