Patient Care Advocate

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❄️ Minnesota – Remote

❄️ Minnesota – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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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 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