Job Description

Patient Advocate

Premier Orthopaedics, in partnership with Philadelphia Hand to Shoulder, is seeking a dedicated and skilled Patient Advocate to join our team! As two of the region's most respected providers of orthopedic and upper extremity care, we offer a collaborative, patient-focused environment that prioritizes clinical excellence, innovation, and ongoing professional development. This is a full time Monday-Friday position.

Position Summary:

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.

Essential Functions:

• 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.
• Contacts patients to acknowledge concerns, gather additional information, and maintain communication throughout the investigation process.
• 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.
• Coordinates investigations with physicians, practice managers, operational leadership, and other departments to ensure concerns are addressed appropriately.
• Escalates complaints requiring additional review to the appropriate leadership team.
• Prepares detailed investigation summaries for leadership review.
• 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.
• Assists patients in navigating the organization by facilitating communication between departments and connecting patients with appropriate resources.
• 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.
• Performs other duties as assigned.

Education:

• Degree in Healthcare Administration, Nursing, Business Administration, Communications, Public Health, or a related field preferred but not required.

Experience:

• 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.
• Experience collaborating with physicians and multidisciplinary healthcare teams preferred.

Knowledge:

• Knowledge of patient relations principles and service recovery best practices.
• 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.

Skills:

• Excellent verbal and written communication skills.
• Strong customer service and interpersonal skills.
• Skill in conflict resolution and de-escalation.
• Skill in conducting investigations and documenting findings.
• Skill in preparing professional correspondence and written determination letters.
• Skill in organization, prioritization, and time management.
• Skill in problem-solving and critical thinking.
• Skill in collaborating effectively with physicians, management, and staff.
• Skill in maintaining professionalism, objectivity, and confidentiality.

Abilities:

• Ability to independently manage patient complaints from receipt through final resolution.
• Ability to investigate concerns objectively and make sound recommendations.
• Ability to establish and maintain effective working relationships with patients, physicians, management, and staff.
• Ability to communicate effectively with individuals in emotionally charged situations.
• Ability to analyze complaint trends and recommend operational improvements.
• Ability to exercise sound judgment while maintaining confidentiality.
• Ability to manage multiple priorities while meeting established response deadlines.

Environmental Working Conditions:

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

Physical/Mental Demands:

• Requires sitting, standing, walking, and occasional bending associated with a normal office environment.
• Requires manual dexterity for computer and telephone use.
• Requires the ability to manage emotionally charged conversations and sensitive situations with professionalism, empathy, and sound judgment.

Organizational Requirements:

• HOPCo's Mission, Vision, and Values must be acknowledged and adhered to.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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