Patient Advocate IIID- 10681
About the position
The Patient Advocate II at Emory Healthcare plays a crucial role in managing patient complaints and grievances, ensuring regulatory compliance, and enhancing the patient experience. This position involves collaboration with various stakeholders to resolve issues, provide training, and support service facilitation requests, all while adhering to federal regulations and organizational policies.
Responsibilities
- Manage the investigation, management, regulatory compliance, and resolution of complaints and grievances.
- Collaborate with team members and external resources to support service facilitation requests.
- Resolve quality of service and quality of care complaints in compliance with regulatory guidelines.
- Adhere to federal regulations and Emory Healthcare policies related to patient rights and responsibilities.
- Serve in an advisory role to share the voice of the patient and identify barriers to service.
- Report to the Patient Experience Director and assist in issue clarification and policy review.
- Responsible for timely intake, prioritization, and delegation of patient complaints and grievances.
- Ensure compliance with regulatory requirements and EHC policy governing patient complaints.
- Lead the creation and distribution of reports for Grievance Review Committee and regulatory agency visits.
- Analyze reports from Risk Management documentation system for trends and improvement opportunities.
- Collaborate with Patient Financial Services on billing complaints as needed.
- Prepare and present patient advocacy training classes, including new employee orientation.
- Respond to inquiries from insurance companies regarding quality of care and service concerns.
- Document investigations and resolutions in the event management system accurately and thoroughly.
- Demonstrate leadership skills in committees and improvement projects to enhance patient experience.
- Perform daily rounds in designated areas and partner with clinical teams to address concerns.
- Manage complex cases with interdisciplinary teams and escalate cases to senior leaders as necessary.
- Engage with leadership to assess case consequences and recommend timely resolutions.
- Work with various departments to provide appropriate responses to patient grievances.
- Facilitate multi-disciplinary groups and arrange family meetings for complaint resolution.
- Identify and investigate matters that may lead to claims or lawsuits in collaboration with risk managers.
- Manage the formal grievance process according to CMS rules and EHC policy.
- Serve as a resource for patients and staff regarding Patient Rights and Responsibilities.
- Advise on content for patient-facing communications to improve patient experience.
- Design service recovery gestures, including decisions on compensation and reimbursement.
- Assist with recovery and resolution of lost belongings.
- Triage incoming concerns and requests via email, phone, and in-person.
- Delegate and assign cases to leaders for follow-up and resolution.
- Work with manager to formulate a personal professional development plan.
- Attend meetings, huddles, and educational in-services as appropriate.
- Participate in improvement projects to enhance workflows and quality of care experience.
- Engage in professional activities to maintain knowledge of current trends and practices.
- Cross-train with other divisions and flex time to support Patient Relations coverage.
Requirements
- 3-5 years of customer service or case management experience.
- Healthcare experience working with clinical teams and/or patients preferred.
- Demonstrated conflict management and problem-solving skills.
- Proficiency in telecommunication skills and using multi-line phones.
Nice-to-haves
- Bachelor's Degree in healthcare preferred.
- Associate degree or case management/customer service experience.
Benefits
- Comprehensive health benefits that start day 1
- Student Loan Repayment Assistance & Reimbursement Programs
- Family-focused benefits
- Wellness incentives
- Ongoing mentorship, development, and leadership programs
