Patient Care Advocate

🔥 13 hours ago

❄️ Minnesota – Remote

❄️ Minnesota – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 16%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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AffirmedRx, a Public Benefit Corporation

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

AffirmedRx is a Public Benefit Corporation dedicated to transforming the pharmacy benefit management (PBM) industry. Focused on transparency, patient-centric care, and innovative solutions, AffirmedRx aims to overcome the complexities and opacity that traditionally plague the PBM sector. By empowering individuals and organizations, the company provides clarity and unwavering support in navigating pharmacy benefits. AffirmedRx stands for integrity and partnership, striving to offer a healthier and more informed pharmacy benefits experience while boldly tackling the rising costs of healthcare and pharmaceuticals.

📋 Description

• Serve as a subject matter expert on pharmacy and medical benefit structures for Medicare, Medicaid, and commercial payers • Interpret coverage and resolve complex benefit questions • Provide guidance across prior authorization and appeals processes 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 benefit, coverage, and authorization questions and determine resolution strategies • Own cases end to end, resolving issues and escalating when warranted • Counsel members and patients on coverage, benefits, and financial assistance options • Partner with members, providers, pharmacies, and other stakeholders 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 (preferred) or equivalent experience • 4+ years of proven experience in pharmacy benefits, managed care, or patient advocacy within a healthcare or PBM setting, including roles 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, with the ability to translate complex benefit and coverage information into clear guidance for members and providers • Strong analytical and problem-solving skills, with the ability to interpret claims and benefit information and navigate complex healthcare and payer systems • A patient-centered approach, with the empathy to support members through difficult or high-stakes situations • Proficiency with claims, benefit verification, and case management systems, and strong general computer skills • Strong organizational skills and attention to detail, with the ability to manage multiple priorities and adapt to changing demands • Ability to work both independently and collaboratively with internal and external stakeholders • Commitment to maintaining patient confidentiality and adhering to ethical and regulatory standards • A 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 and the business thrives • Remote work arrangement