BCforward is currently seeking a highly motivated HEDIS Patient Care Advocate for an opportunity in Elkhart, IN
Position Title: HEDIS Patient Care Advocate
Location: Elkhart, IN
Duration: 3 months with possibility to extend
Shift Timing: Monday–Friday, 8:00 AM–5:00 PM.
Pay Rate: $34/hr
Position Summary
The Patient Care Advocate serves as a liaison between members, families, healthcare providers, medical groups, and facilities. This role focuses onmember outreach, care-gap closure, appointment coordination, health education, and provider quality improvement.
The selected candidate will work directly within assigned provider/clinical facilities and must be comfortable working independently while communicating with members, providers, and internal teams.
Key Responsibilities
- Serve as a liaison and advocate between members/families, physicians, providers, medical groups, and healthcare facilities.
- Work directly with provider office staff to support healthcare quality and member outcomes.
- Conducttelephonic outreach and health coachingto members.
- Conductface-to-face educationwith members and families regarding identified care gaps and barriers to care.
- Identify members who have gaps in preventive or required healthcare services and help coordinate appropriate follow-up.
- Schedule doctor appointments for members to address care gaps and improve access to preventive care.
- Arrange transportation and follow-up appointments when needed.
- Educate provider practices regardingHEDIS measures and HEDIS-related ICD-10/CPT codingin accordance with NCQA requirements.
- Review provider performance data and identify opportunities for quality improvement.
- Work with Provider Relations and other departments to improve provider performance related toQuality, Risk Adjustment, Operations, claims, and encounters.
- Coordinate with Customer Service, Case Management, Disease Management, and other departments to resolve member issues.
- Refer members to case management or disease management programs when appropriate.
- Maintain accurate documentation of member contacts, outreach activities, appointments, referrals, and follow-up.
- Complete special projects and other duties as assigned.
- Follow all company policies, procedures, and regulatory requirements.
Candidate Requirements
Required Education / Experience
- Bachelor's degree inHealthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or a related healthcare field,OR equivalent work experience.
- A total of4 years of relevant experienceis required.
- At least2 years of experienceshould ideally be in:
- Direct patient care
- Social work
- Quality improvement
- Health coaching
- Managed care
- Experience working in anambulatory/outpatient healthcare practiceis required.
- Experience withHEDIS review, chart abstraction, or HEDIS measuresis highly relevant.
Preferred Licensure / Certification
One of the following is preferred:
- RN – Registered Nurse
- LPN – Licensed Practical Nurse
- LMSW – Licensed Master Social Worker
- LSW – Licensed Social Worker
C-SW – Certified Social Worker
Benefits:
BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
