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...

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Patient Care Advocate - Minnesota

12 hours, 56 minutes ago

United States

Full-time

Senior

Customer Support

Customer and Technical Support

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AffirmedRx

Insurance

1-10

View All Jobs 2

Description

Serve as a subject matter expert on pharmacy and medical benefit structures across Medicare, Medicaid, and commercial payers.
Guide members and providers through prior authorization and appeals for prescription medications.
Assess eligibility for copay and financial assistance and connect patients with third-party support when appropriate.
Interpret PBM regulations, policies, and industry developments to inform patient guidance and decisions.
Independently evaluate complex benefit, coverage, and authorization questions and determine resolution strategies.
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 internal teams to remove barriers to care.
Analyze claims against benefit guidelines and identify discrepancies and corrective actions.
Conduct benefit verification and test claims to validate coverage and support resolution.
Maintain accurate case documentation and explain the rationale behind decisions.
Evaluate interaction quality, identify trends, 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 exercising independent judgment and decision-making in prior roles.
Strong knowledge of pharmacy and medical benefit structures, prior authorization and appeals, healthcare regulations, and payer/insurance processes.
Excellent communication and interpersonal skills.
Strong analytical and problem-solving skills for interpreting claims and benefit information.
Patient-centered approach with empathy for members in high-stakes situations.
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 with internal and external stakeholders.
Commitment to patient confidentiality and ethical, regulatory compliance.
Private, quiet workspace for remote work.

Benefits

Competitive compensation.
Health, dental, and vision benefits.
Opportunity to help improve pharmacy benefits management and patient outcomes.
Remote work with expectations for a professional, distraction-free workspace.
Culture focused on team success and employee growth.

Interested in this position?

Apply directly on the company website

Apply Now

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