Full-Time Advocate

Job Description Title: Patient Advocate
Premier Orthopaedics, in partnership with Philadelphia Hand to Shoulder
Premier Orthopaedics, in partnership with Philadelphia Hand to Shoulder, is seeking a dedicated and skilled Patient Advocate to join our team! This is a full time Monday-Friday position.

Responsible for managing the organization's patient complaint and grievance process from initial receipt through final resolution. Serves as the primary point of contact and voice of the practice for patients with concerns, complaints, or grievances by ensuring issues are investigated thoroughly, communicated appropriately, and resolved in a timely, professional, and compassionate manner. Coordinates with physicians, operational leadership, Compliance, Risk Management, and other departments to facilitate investigations, identify and escalate potential compliance or patient safety concerns, prepare case summaries, communicate outcomes to patients, and issue written determination letters in accordance with organizational policies and regulatory requirements.

Serves as the primary point of contact for all patient complaints, grievances, concerns, and service recovery matters.

• Collaborate with Compliance and Risk Management to identify, escalate, and report patient concerns, grievances, and potential compliance or patient safety issues in accordance with organizational policies and regulatory requirements.
• Owns the patient complaint and grievance process from initial receipt through final resolution.
• Receives, reviews, documents, and summarizes patient complaints for leadership review.
• Serves as the voice of the practice by ensuring patients receive timely, professional, compassionate, and consistent communication.
• Investigates complaints by interviewing patients, physicians, managers, and staff and reviewing medical records and other relevant documentation.
• Escalates complaints requiring additional review to the appropriate leadership team.
• Drafts written determination and resolution letters communicating investigation findings and outcomes to patients.
• Ensures patient grievances are acknowledged, investigated, and responded to within established organizational and regulatory timeframes.
• Maintains accurate documentation of all complaints, investigations, correspondence, and resolutions within a designated tracking system.
• Monitors complaint trends and prepares recurring reports for leadership to identify opportunities for operational improvement.
• Partners with leadership to recommend corrective actions and process improvements based on complaint trends.
• Collaborates with physicians, clinical staff, and administrative staff to promote patient satisfaction and service excellence.
• Maintains strict confidentiality and complies with HIPAA, CMS grievance requirements, and all organizational policies and procedures.
• Participates in patient experience initiatives, quality improvement projects, and special assignments as requested.
• Degree in Healthcare Administration, Nursing, Business Administration, Communications, Public Health, or a related field preferred but not required.

Minimum of three (3) years of experience in healthcare, patient relations, physician practice operations, or healthcare administration.

• Experience investigating and resolving patient complaints or grievances preferred.
• Experience working in a multi-site physician practice or outpatient healthcare setting preferred.
• Knowledge of physician practice operations and outpatient healthcare workflows.
• Knowledge of HIPAA, patient privacy regulations, and healthcare compliance requirements.
• Knowledge of CMS patient grievance requirements and complaint resolution processes preferred.
• Knowledge of Microsoft Office applications and electronic medical record (EMR) systems.

Strong customer service and interpersonal skills.

• Skill in conducting investigations and documenting findings.
• Ability to independently manage patient complaints from receipt through final resolution.
• Ability to analyze complaint trends and recommend operational improvements.

~ ENVIRONMENTAL WORKING CONDITIONS

• Normal office and outpatient clinical environment.
• Occasional travel between practice locations as needed.

Requires sitting, standing, walking, and occasional bending associated with a normal office environment.

• Requires manual dexterity for computer and telephone use.