Patient Care Advocate

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

📋 Description

• Act as a subject matter expert regarding pharmacy and medical benefit frameworks across Medicare, Medicaid, and various commercial payers.

• Offer guidance throughout the prior authorization and appeals procedures for prescription medications.

• Evaluate eligibility for copay and financial assistance, connecting patients with external support resources.

• Analyze PBM regulations, policies, and industry trends.

• Address intricate benefit, coverage, and authorization inquiries, providing resolution guidance.

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

• Advise members and patients on available coverage, benefits, and financial support options.

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

• Review claims against benefit criteria and identify necessary corrective actions.

• Perform benefit verifications and conduct claims testing.

• Ensure precise case documentation and rationale for decisions.

• Assess quality, identify trends, and suggest improvements to processes.

⛳️ Requirements

• Residency in Minnesota with willingness to travel within the state.

• Bachelor's degree in a healthcare-related discipline is preferred, or equivalent experience.

• A minimum of 4 years of experience within pharmacy benefits, managed care, or patient advocacy in a healthcare or PBM environment.

• Experience necessitating independent judgment and decision-making capabilities.

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

• Exceptional communication and interpersonal abilities to clearly articulate complex benefit and coverage information.

• Strong analytical skills and problem-solving aptitude.

• Proficiency in claims processing, benefit verification, and case management software.

• Solid general computer skills.

• Excellent organizational skills with keen attention to detail.

• Capability to manage various priorities and adapt to evolving demands.

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

• Commitment to maintaining 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 additional benefits.

• Chance to influence change within the pharmacy benefits management sector while ensuring high-quality patient outcomes.

• A thriving workplace culture.

• Opportunity for remote work in a private, quiet environment.