Patient Advocate

Laguna Beach, CA 92653

Employment Type: Direct Job Category: Claims Job Number: 46696

Our client, an established and rapidly growing Healthcare Technology company is seeking a sharp, ambitious Patient Account Representative to assist members, providers and healthcare professionals in navigating through payment, billing, and claims issues in a complex health system. Candidate must have experience working claims for Hospital Billing/TPA and have experience with Provider Negotiation and/or Vendor Relationship Management. The Patient Advocate will serve as a liaison between patients and provider plans, communicating patients questions and concerns, and investigate complaints and claims as needed. Patient advocates need a working knowledge of the health care system, including a solid understanding of medical terminology, health care financing, available benefits programs and patients' rights.


  • Handling client/provider inquiries and appeals and member calls related to their Medical Plan and balance billing situations.
  • A high level of professionalism, organization and flexibility are essential in this position.


  • Manage provider and member inquiries, appeals and balance billing; including correspondence.
  • Keep clients informed of all disputes and status; providing reporting as necessary.
  • Communicate with department heads
  • Review and prioritize claims based on processing/regulatory criteria, timelines, interdepartmental demands, member benefits, etc.
  • Evaluate and research claims and make decisions on how best to interact with clients, providers and members.
  • Contact facilities and providers to discuss charge adjustments and rationale while obtaining signed agreements for reimbursement or adjustments when needed
  • Participate in on-going process improvement to develop efficiencies that streamline processes in department


  • 3+years of experience in a medical claims role dealing both providers and members, provider negotiation, hospital billing, claims adjudication and ability to interpret benefit plans
  • 1+ years of experience in healthcare insurance company/TPA/hospital setting with emphasis in claims, fee schedules, contracting, or vendor relations
  • Familiarity with Reference-Based Pricing (RBP) and/or Value-Based Payment systems
  • Exceptional communication and organizational skills
  • Ability to develop and maintain long-term working relationships with providers
  • Possess a strong knowledge base of claim auditing, coding, and pricing with an emphasis in researching solutions as needed


  • Growing organization at the forefront of changing healthcare environment
  • M F standard business hours, PTO, Vacation, Holiday Pay
  • Excellent starting compensation ($50-$55K) and benefits package!

Please submit your resume to learn more about our client!

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