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Patient Advocate Foundation
Phone: (800) 532-5274
Fax: (757) 873-8999
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Career Opportunities


Patient Advocate Foundation (PAF), a national non-profit, headquartered in Hampton, VA, has been solving insurance and healthcare problems since 1996. Our mission is to eliminate patient obstacles to access quality health care. We provide assistance to patients through effective mediation to assure access to quality health care, maintenance of employment and preservation of financial stability.



Clinical Case Manager

About Us

Patient Advocate Foundation (PAF), a national non-profit, headquartered in Hampton, VA, has been solving insurance and healthcare problems since 1996.  Our mission is to eliminate patient obstacles to access quality health care.  We provide assistance to patients through effective mediation to assure access to quality health care, maintenance of employment and preservation of financial stability.  To read more about us, please visit our website at www.patientadvocate.org.

The Opportunity

PAF is currently seeking a Clinical Case Manager to join our team.  A Clinical Case Manager at PAF serves as an active liaison between patients and their insurers, employers and/or creditors to resolve insurance, job retention and/or debt crisis matters relative to their diagnosis.  They seek to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their financial stability.  They further explore reimbursement levels for prescribed treatments, research available clinical trials for the patient population and facilitate enrollment into appropriate patient resource programs for both uninsured and underinsured patients.  

In this role, a Clinical Case Manager will be responsible for:

  • Assisting patients with insurance, job retention and debt resolution matters
  • Providing assistance & research, during all levels of health insurance appeals, with clinically sensitive cases
  • Verifying and/or enter data into the Case Management database in a timely manner 
  • Reviewing and interpreting the level of benefit coverage for prescribed therapies
  • Coordinating and managing the process of submission, intervention and resolution of appeals, grievances and/or complaints
  • Assuring timeliness and appropriateness of all appeals based on insurance or state/federal guidelines
  • Negotiating coverage for experimental and investigational procedures on an individual basis
  • Working collaboratively with providers to obtain pre-authorizations for prescribed treatments and therapies
  • Researching various resources to supplement the limits of insurance and/or facilitate access to care for uninsured patients
  • Coordinating and manages communications with providers and/or partner contacts regarding denials, appeals and reviews
  • Mediating with insurance companies, medical providers, and/or other 3rd party entities on behalf of patients when necessary to bring resolution
  • Directly negotiating insurance coverage within the public sector, private sector and/or Marketplace options, for prescribed treatments and pharmaceutical therapies relative to treatment
  • Delivering electronically or via the mail appropriate packets to patients, including letters, surveys and/or authorization forms, when applicable

Qualifications   

Required:

  • 3+ years of experience in a health care or insurance environment
  • Proven experience handling the appeals process, including filing appeals
  • Ability to assist patients telephonically and type at the same time
  • Comprehensive medical and insurance terminology
  • Maintain confidentiality while handling PHI
  • Skilled at exercising initiative, judgment, discretion and decision making to achieve organizational objectives
  • Excellent oral and written communication skills
  • Knowledgeable in MS Office Suite and databases
  • Ability to work independently, remain flexibility and maintain composure under pressure

Desired:

  • Bachelor’s degree in healthcare or relevant field, preferred
  • LPN or Clinical Social Work License
  • Preferred knowledge and experience in one or more of the following areas: Insurance and reimbursement, coding/billing, pre-authorizations, utilization review and discharge planning, and claims experience in a managed care setting.

Our Benefits 

PAF is pleased to offer our employees a comprehensive benefit package. We are committed to bring financial health and prosperity to the people of our organization which is reflected in a total compensation package.  Our benefits include:  health, dental & visions options, paid holidays, vacation, sick & personal leave, paid winter shut down, STD/LTD,  group life & AD&D insurance, group cancer & accident plans, 401k with matching, and various wellness programs.    

To Apply

This is an incredible opportunity to join an organization that makes a difference!

 Click Here to Apply

One team, one mission – Are you ready to make a difference?



Case Manager

About Us
Patient Advocate Foundation (PAF), a national non-profit, headquartered in Hampton, VA, has been solving insurance and healthcare problems since 1996.  Our mission is to eliminate patient obstacles to access quality health care.  We provide assistance to patients through effective mediation to assure access to quality health care, maintenance of employment and preservation of financial stability.  To read more about us, please visit our website at www.patientadvocate.org.

The Opportunity

PAF is currently seeking a Case Manager to join our team.  A Case Manger at PAF serves as an active liaison between patients and their insurers, employers and/or creditors to resolve insurance, job retention and/or debt crisis matters relative to their diagnosis.  They seek to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their financial stability.  They further explore reimbursement levels for prescribed treatments, research available clinical trials for the patient population and facilitate enrollment into appropriate patient resource programs for both uninsured and underinsured patients.    

In this role, a Case Manager will be responsible for:

  • Assisting patients with insurance, job retention and debt resolution matters
  • Verifying and/or entering data into the Case Management database in a timely manner 
  • Screening and submitting applications for patients into Medicaid, Medicare, and/or extra help when appropriate
  • Directly evaluating and selecting the top plans for patients seeking enrollment into an insurance product within the public, private sector and/or Marketplace
  • Researching and applying for financial relief related to cost of living challenges and transportation/lodging needs related to illness
  • Determining eligibility and special enrollment guidelines into COBRA or other health plans to eliminate access to care barriers
  • Researching various resources to supplement the limits of insurance and/or facilitate access to care for uninsured patients
  • Providing assistance in securing and expediting applications for SSDI, SSI, SCHIPS, Medicaid and other social programs
  • Appeal denials related to disability and/or health insurance enrollment
  • Securing and assisting in the completion of forms;  submitting to proper agencies while maintaining regular contact to ensure processing with continued updates provided to patients
  • Mediating with insurance companies, medical providers, and/or other 3rd party entities on behalf of patients when necessary to bring resolution
  • Delivering electronically or via the mail appropriate packets to patients, including letters, surveys and/or authorization forms, when applicable

Qualifications  

Required:

  • 2+ years of experience in one of the following areas: health care environment, social work or commercial insurance
  • Ability to assist patients telephonically and type at the same time
  • Skill at exercising initiative, judgment, discretion and decision making to achieve organizational objectives
  • Excellent oral and written communication skills
  • Knowledgeable in MS Office Suite and databases
  • Ability to work independently, remain flexibility and maintain composure under pressure

Desired:

  • Bachelor’s degree in human services or social work
  • Preferred experience in one or more of the following areas: Healthcare industry, Medicare, Medicaid, commercial insurance and/or Marketplace, Social Security programs

Our Benefits 

PAF is pleased to offer our employees a comprehensive benefit package. We are committed to bring financial health and prosperity to the people of our organization which is reflected in a total compensation package.  Our benefits include:  health, dental & visions options, paid holidays, vacation, sick & personal leave, paid winter shut down, STD/LTD,  group life & AD&D insurance, group cancer & accident plans, 401k with matching, and various wellness programs.    
 

To Apply

This is an incredible opportunity to join an organization that makes a difference!

Click Here to Apply

One team, one mission – Are you ready to make a difference?


 

Business Analyst

 

About Us

Patient Advocate Foundation (PAF), a national non-profit, headquartered in Hampton, VA, has been solving insurance and healthcare problems since 1996.  Our mission is to eliminate patient obstacles to access quality health care.  We provide assistance to patients through effective mediation to assure access to quality health care, maintenance of employment and preservation of financial stability.  To read more about us, please visit our website at www.patientadvocate.org.

The Opportunity

PAF is seeking a Business Analyst to join our IT department.  The Business Analyst's role is to plan, design, develop, and launch efficient business systems in support of core organizational functions and business processes. This includes gathering and analyzing data in support of business cases, proposed projects, and systems requirements. This role is also responsible for generating and compiling reports based on their findings, complete with probable causes and possible solutions to systems issues. This individual will apply proven communication, analytical, and problem-solving skills to help maximize the benefit of IT system investments.

In this role, the Business Analyst will have the following responsibilities:

  • Performs systems (including application, databases, files, etc.,) analysis in order to define /propose solutions to problems and/or enhancements
  • Defines project requirements by identifying project milestones, phases, and elements; estimates efforts and project resource needs
  • Follows the SDLC process including (but not limited to) the creation of Project Scope, Requirements, Test Plan, Implementation Plan documents
  • Works directly with all levels of leadership and front line staff to lead requirements gathering and review sessions; as well as other meetings
  • Coordinates enhancement releases
  • Performs analysis to exercise trouble shooting skills while determining root cause of problems/defects
  • Determines operational objectives by studying business functions, gathering information, and evaluating output requirements and formats
  • Designs new computer programs by analyzing requirements, constructing workflow charts and diagrams, studying system capabilities and writing specifications
  • Improves systems by studying current practices
  • Recommends controls by identifying problems
  • Maintains system protocols by writing and updating IT procedures
  • Provides references for users by writing and maintaining user documentation, providing help desk support and/or training users
  • Prepares technical reports by collecting, analyzing, and summarizing information and trends
  • Provides guidance to nontechnical users in best usage of software
  • Design and configure rules and flows and assist with the draft UI and draft flow development
  • Create wireframes and other UT artifacts to assist in the development process

Required Qualifications

  • Bachelor’s Degree in related field
  • 3+ years of experience required in roles of business analyst, consulting and/or project management, preferably in the healthcare and/or medical insurance industry
  • Work experience with Business Process Management, Rules engines, and Workflow software (preferable Pega PRCA)
  • Advanced skills with MS Office Excel and SQL
  • Familiarity with regulatory compliance issues related to HIPAA (Health Insurance Portability and Accountability Act)

Our Benefits 

PAF is pleased to offer our employees a comprehensive benefit package. We are committed to bring financial health and prosperity to the people of our organization which is reflected in a total compensation package.  Our benefits include:  health, dental & visions options, paid holidays, vacation, sick & personal leave, paid winter shut down, STD/LTD,  group life & AD&D insurance, group accident & cancer policies, 401k with matching, and various wellness programs.  

To Apply

This is an incredible opportunity to join an organization that makes a difference!  To apply, please send your cover letter and resume to: Click Here to Apply 

 

PAF is an Equal Opportunity Employer