RemoteLeaf Logo
Log in Sign up

Patient Care Advocate - Minnesota

52 minutes ago
United States
Full-time
Mid Level
Customer Support
Customer and Technical Support
Apply Now
AffirmedRx

AffirmedRx

AffirmedRx is a pharmacy benefit management company dedicated to enhancing healthcare outcomes through integrity, clarity, and trust. They prioritize making pharmacy benefits easy to understand, accessible, and aligned with the best interests of employ...

Insurance
1-10
View All Jobs 3

Description

  • Serve as a subject matter expert on pharmacy and medical benefit structures across Medicare, Medicaid, and commercial plans.
  • Provide guidance on prior authorization and appeals for prescription medications.
  • Assess eligibility for copay and financial assistance programs and connect patients with appropriate resources.
  • Interpret PBM regulations, policies, and industry developments to inform patient guidance and decisions.
  • Independently evaluate benefit, coverage, and authorization questions from members and providers.
  • Own cases end to end and escalate issues only when necessary.
  • Counsel members and patients on coverage, benefits, and financial assistance options.
  • Partner with members, providers, pharmacies, and community resources to remove barriers to care.
  • Analyze claims against benefit guidelines and identify discrepancies for correction.
  • Conduct benefit verification and test claims, maintain documentation, 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 preferred, or equivalent experience.
  • 4+ years of experience in pharmacy benefits, managed care, or patient advocacy in a healthcare or PBM setting.
  • Experience requiring independent judgment and decision-making.
  • Strong knowledge of pharmacy and medical benefit structures, prior authorization, appeals, healthcare regulations, and payer/insurance processes.
  • Excellent communication and interpersonal skills with the ability to explain complex benefit information clearly.
  • Strong analytical and problem-solving skills for interpreting claims and benefit information.
  • Proficiency with claims, benefit verification, and case management systems, plus strong general computer skills.
  • Strong organizational skills, attention to detail, and ability to manage multiple priorities.
  • Ability to work independently and collaboratively while maintaining patient confidentiality and ethical standards.
  • Private, quiet workspace for remote work.

Benefits

  • Competitive compensation.
  • Health, dental, and vision benefits.
  • Opportunity to impact change in the pharmacy benefits management space.
  • Work in a culture focused on team success and performance.
  • Remote work with expectations for a professional, distraction-free workspace.

Interested in this position?

Apply directly on the company website

Apply Now

Similar Roles

Nadia Care

Bilingual Maternity Navigator

Nadia Care Health Care Providers & Services

Nadia Care is hiring a Bilingual Maternity Navigator to support expectant and new mothers in South Memphis and surrounding neighborhoods through community-based, virtual, and in-person maternity care navigation and education.

United States Full-time Mid Level Customer Support
$37k-$48k
macOS
37 minutes ago
Sunrise Group

Patient Care Coordinator

Sunrise Group 51-250 Internet Software & Services

Dreem Health, part of Sunrise Group, is hiring a Patient Care Coordinator to support and improve the patient experience at a fast-growing digital sleep clinic delivering home-based sleep care.

United States Full-time Entry Level Customer Support
$44k-$52k
37 minutes ago
A

Work From Home - Client Benefits Advisor

AO Garcia Agency Insurance

Global Elite Empire Consultants is hiring a client service leadership role focused on delivering customer support from home while growing within a flexible, mentorship-driven environment.

United States Lead Customer Support
37 minutes ago
A

Benefits Services Representative - Remote

AO Garcia Agency Insurance

Global Elite Empire Consultants is hiring a remote client-facing benefits guide to meet with interested prospects, help them understand and enroll in benefit options, and grow within a performance-based role.

Canada Entry Level Customer Support
37 minutes ago

You're on a roll! Sign up now to keep applying.

Sign Up

Already have an account? Log in

Used by 14,729+ remote workers