Patient Care Advocate

This is a fully remote position, open to applicants in Minnesota.

📋 Description

• Act as a subject matter expert on pharmacy and medical benefit frameworks across Medicare, Medicaid, and various commercial payer types.

• Assist patients in navigating the prior authorization and appeals processes for prescription medications.

• Evaluate eligibility for copay and financial assistance while connecting patients with third-party support.

• Analyze PBM regulations, policies, and industry trends.

• Address complex inquiries regarding benefits, coverage, and authorizations from both members and providers.

• Manage cases from start to finish and escalate issues as necessary.

• Provide guidance to members and patients on coverage, benefits, and financial aid options.

• Collaborate with members, providers, pharmacies, and community organizations to eliminate barriers to care.

• Review claims against benefit guidelines and determine necessary corrective actions.

• Perform benefit verifications and test claims.

• Ensure accurate case documentation and rationales for decisions made.

• Assess quality, identify trends, and suggest process enhancements.

⛳️ Requirements

• Must reside in Minnesota and be open to traveling within the state.

• A bachelor's degree in a healthcare-related discipline (preferred) or equivalent experience.

• Minimum of 4 years of demonstrated experience in pharmacy benefits, managed care, or patient advocacy within a healthcare or PBM environment, including roles that require independent judgment and decision-making.

• In-depth knowledge of pharmacy and medical benefit structures, prior authorization and appeals, healthcare regulations, and payer/insurance processes.

• Exceptional communication and interpersonal skills, capable of translating complex benefit and coverage information into clear guidance for members and providers.

• Strong analytical and problem-solving abilities, with the capacity to interpret claims and benefit information while navigating intricate healthcare and payer systems.

• A patient-centered mindset, with the empathy needed to support members during challenging or critical situations.

• Proficient in claims, benefit verification, and case management systems, along with strong general computer skills.

• Excellent organizational skills and attention to detail, able to manage multiple priorities and adjust to evolving demands.

• Ability to work independently and collaboratively with both internal and external stakeholders.

• Commitment to maintaining patient confidentiality and adhering to ethical and regulatory standards.

• A private, quiet workspace suitable for remote work.

🏝️ Benefits

• Competitive salary, including health, dental, vision, and additional benefits.

• Remote work flexibility.

• Opportunity to influence industry changes in the pharmacy benefits management sector while enhancing patient outcomes.

• A culture that prioritizes both employee and business success.