Patient Care Advocate

🔥 16 hours ago

🌲 Oregon, Washington – Remote

🌲 Oregon – Remote ☕ Washington – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 19%

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 • Guide patients and providers through prescription medication prior authorization and appeals processes • Assess eligibility for copay and financial assistance and connect patients with third-party resources • Interpret PBM regulations, policies, and industry developments • Assess complex benefit, coverage, and authorization questions and communicate resolution guidance • Own cases end to end, resolving issues and escalating when warranted • Counsel members and patients on coverage, benefits, and financial assistance options • Collaborate 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 rationale • Evaluate quality, identify trends, and recommend process improvements

🎯 Requirements

• Must reside in the state of Washington or Oregon • 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 ability to translate complex benefit and coverage information into clear guidance • Strong analytical and problem-solving skills, including interpreting claims and benefit information and navigating complex healthcare and payer systems • Patient-centered approach and empathy for difficult or high-stakes situations • Proficiency with claims, benefit verification, and case management systems, plus 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 and the business thrives • Remote work arrangement