Do you have a background or interest in the health care field?
Are you compassionate and patient, yet politely assertive?
Are you a problem solver, with great attention to detail?
If so, you might want to consider a career as a health advocate. Cited as an “up-and-coming” industry by Forbes magazine, health advocates are becoming more and more in demand as our population ages (making more use of health services) and the health care industry becomes increasingly complex.
For many individuals, understanding basic health care terms (deductible, copay, premium) is a challenge. Some 77 million Americans — regardless of formal education level — have basic or below basic health literacy, which means they have trouble reading prescription drug labels and pamphlets on medical topics.
Without a firm grasp on the fundamentals — such as the difference between in- and out-of-network providers — consumers can’t be expected to manage more complex challenges, such as how to detect errors on a medical bill or knowing that the same procedure can vary by thousands of dollars depending on the provider. In fact two-thirds of insured consumers reportedly do not feel comfortable with their ability to navigate the health care system.
Enter the health care advocate. Advocates are a lifeline for individuals as they try to select benefits during open enrollment, identify qualified yet affordable providers, manage a serious health condition or interpret medical bills. The role is an important one, offering a lot of flexibility and the opportunity to truly improve the lives of others.
An advocate’s day-to-day
Depending on the employer (an independent advocacy services provider, a hospital or other health care or health insurance provider or a non-profit agency), advocates may be tasked with a wide range of responsibilities, including:
- Helping clients make informed decisions about available coverage or treatment options
- Answering questions about benefits coverage and cost-sharing
- Ensuring patients and their family members understand diagnoses and recommended procedures
- Researching and explaining alternative treatment options
- Coordinating care across multiple health providers
- Overseeing case management and discharge planning
- Arranging for second opinions or appointments with specialists
- Obtaining cost estimates for recommended tests and procedures
- Representing clients with insurance companies and health care providers on claims and billing issues
As field experts, advocates are expected to be able to answer many of these questions, though some will require outbound calls to providers or insurance carriers. Fortunately, advocates have a vast industry network at their fingertips, which they can tap to help employees research network status, locate in-network providers, find providers for second opinions and even schedule appointments.
One of the health advocate’s most important functions — and where they can have a real impact on both consumers’ wallets and their understanding of how the health care system works — is helping to investigate procedure prices. By leveraging their network list, advocates can gather cost and quality data for the same procedure across different providers and ensure clients find the best-priced option for their needs.
Once employees have received treatment, advocates can also make sure they are being charged fairly by checking medical bills for inaccuracies and working with insurance carriers to research claim issues or resolve denied claims for clients.
What does it take to be an advocate?
First and foremost, an advocate must have a passion for helping people. This drive, regardless of educational or professional background, fuels the job and is an important indicator for future success. The best advocates possess patience, empathy and strong communication skills to ensure they can answer employees’ often complex questions with clear and concise explanations. They are also equipped with exceptional critical thinking and problem-solving skills — enabling them to lead employees through difficult benefits challenges — coupled with an attention to detail to ensure nothing is overlooked.
Before transitioning into advocacy work, many advocates have at least two to four years of experience in the health care field: nursing, hospital administration, benefits, claims, billing or medical coding. In many cases, advocates have worked at insurance companies — giving them a unique perspective on what to look for in claims or what channels to access. While such experience is helpful, it’s not always required — as long as the individuals are willing to learn. (While there are certificate and degree programs in health advocacy available, there is no national certification or standard — so on-the-job training is also an option.)
Regardless of previous experience, most advocates will undergo training to ensure a common baseline knowledge of health care systems. This often includes classroom training that covers health care basics and the tools and resources that they will use on the job. Advocates must learn to be health care librarians — it’s impossible to memorize every health care document and code, but they must know how it find it when needed.
Health care advocates are dedicated to working on behalf of patients to ensure that they’re represented fairly and won’t be taken advantage of as they navigate the complicated health care journey.The can play an essential role in helping Americans choose and use their health coverage wisely, get the care they need and pay appropriately for that care.
Bridget Lipezker, SVP and General Manager, Advocacy and Transparency, DirectPath.