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Patient Care Advocate - Washington/Oregon

1 hour, 57 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
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Description

  • Serve as a subject matter expert on Medicare, Medicaid, and commercial pharmacy and medical benefits.
  • Guide members and providers through prescription prior authorization and appeals processes.
  • Assess eligibility for copay and financial assistance programs and connect patients with appropriate resources.
  • Resolve complex benefit, coverage, and authorization questions while owning cases through completion.
  • Counsel members and patients on benefits, coverage, and financial assistance options.
  • Collaborate with members, providers, pharmacies, and internal stakeholders to remove barriers to care.
  • Analyze claims, conduct benefit verification, and test claims to validate coverage and determine corrective action.
  • Maintain accurate case documentation, evaluate quality trends, and recommend process improvements.

Requirements

  • Must reside in Washington or Oregon and have a private, quiet workspace for remote work.
  • 4+ years of experience in pharmacy benefits, managed care, patient advocacy, healthcare, or a PBM setting.
  • Bachelor’s degree in a healthcare-related field preferred, or equivalent experience.
  • Strong knowledge of pharmacy and medical benefits, prior authorization, appeals, healthcare regulations, and payer processes.
  • Excellent communication skills with the ability to explain complex coverage information clearly.
  • Strong analytical, problem-solving, organizational, and attention-to-detail skills.
  • Experience with claims, benefit verification, and case management systems, plus strong general computer skills.
  • Ability to work independently and collaboratively while exercising sound judgment.
  • Patient-centered approach and commitment to confidentiality, ethical standards, and regulatory compliance.

Benefits

  • Competitive compensation.
  • Health, dental, vision, and other benefits.
  • Opportunity to influence change in pharmacy benefits management and improve patient outcomes.
  • Remote work environment.

Interested in this position?

Apply directly on the company website

Apply Now

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