Patient Care Advocate
Posted 23ds ago
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Job Description
Patient Care Advocate helping Minnesota members navigate pharmacy benefits at AffirmedRx, a pharmacy benefit manager. Resolving coverage, authorization, claims, and financial assistance issues.
Responsibilities:
- Serve as a subject matter expert on pharmacy and medical benefit structures across Medicare, Medicaid, and commercial payer types
- Provide guidance through the prior authorization and appeals process for prescription medications
- Assess eligibility for copay and financial assistance and connect patients with third-party assistance
- Interpret PBM regulations, policies, and industry developments
- Assess complex benefit, coverage, and authorization questions and communicate resolution guidance
- Own cases end to end and escalate when warranted
- Counsel members and patients on coverage, benefits, and financial assistance options
- Partner with members, providers, pharmacies, and community-based resources to remove barriers to care
- Analyze claims against benefit guidelines and determine corrective action
- Conduct benefit verification and test claims
- Maintain accurate case documentation and decision rationales
- Evaluate quality, identify trends, and recommend process improvements
Requirements:
- Must live in Minnesota and be willing to travel within the state
- Bachelor's degree in a healthcare-related field is preferred, or equivalent experience
- 4+ years of experience in pharmacy benefits, managed care, or patient advocacy within a healthcare or PBM setting
- Experience requiring independent judgment and decision-making
- Strong knowledge of pharmacy and medical benefit structures, prior authorization and appeals, healthcare regulations, and payer/insurance processes
- Excellent communication and interpersonal skills to explain complex benefit and coverage information clearly
- Strong analytical and problem-solving skills
- Proficiency with claims, benefit verification, and case management systems
- Strong general computer skills
- Strong organizational skills and attention to detail
- Ability to manage multiple priorities and adapt to changing demands
- Ability to work independently and collaboratively with internal and external stakeholders
- Commitment to patient confidentiality and ethical and regulatory standards
- Private, quiet workspace for remote work
Benefits:
- Competitive compensation, including health, dental, vision and other benefits
- Opportunity to impact industry change in the pharmacy benefits management space while delivering high-quality patient outcomes
- Culture where people thrive
- Remote work with a private, quiet workspace
