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 with the prior authorization and appeals processes for prescription medications.

• Evaluate eligibility for copay and financial support, facilitating connections with third-party assistance.

• Analyze PBM regulations, policies, and industry changes to counsel patients and inform decisions.

• Address complex inquiries regarding benefits, coverage, and authorizations, determining effective resolution strategies.

• Manage cases from start to finish, resolving issues and escalating when necessary.

• Provide guidance to members and patients regarding coverage, benefits, and financial assistance alternatives.

• Collaborate with members, providers, pharmacies, and other stakeholders; coordinate resources available in the community.

• Review claims in relation to benefit guidelines and determine necessary corrective actions.

• Conduct benefit verifications and test claims to confirm coverage.

• Keep accurate documentation of cases and the rationale behind decisions.

• Assess quality, identify patterns, 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.

• Over 4 years of demonstrated experience in pharmacy benefits, managed care, or patient advocacy within a healthcare or PBM environment, including positions necessitating 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 understandable guidance.

• Strong analytical and problem-solving capabilities, with the ability to interpret claims and benefits information while navigating intricate healthcare and payer systems.

• A patient-centered mindset and empathy for assisting 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; capability to manage multiple priorities and adapt to evolving demands.

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

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

• A private, quiet workspace suitable for remote work.

🏝️ Benefits

• Competitive compensation package, including health, dental, vision, and other benefits.

• Opportunity to influence industry change within the pharmacy benefits management sector while achieving high-quality patient outcomes.

• A thriving culture that supports personal and professional growth.

• Flexible remote work arrangement.