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Patient Care Advocate
AffirmedRx, a Public Benefit Corporation. Serve as a subject matter expert on pharmacy and medical benefit structures for Medicare, Medicaid, and commercial payers .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in pharmacy and medical benefit structures, including prior authorization and appeals processes, while effectively communicating complex information to members and providers. Strong analytical skills are essential for interpreting claims and navigating healthcare systems, ensuring patient-centered support and compliance with regulations.
Highest-signal resume keywords
Pharmacy Benefits ExpertisePrior Authorization KnowledgeClaims AnalysisPatient Advocacy ExperienceHealthcare Regulations Understanding
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Benefit VerificationClaims ProcessingCase ManagementDecision-MakingAnalytical Skills
Soft Skills
Excellent CommunicationInterpersonal SkillsOrganizational SkillsProblem-SolvingEmpathy
Tools & Technologies
Case Management SystemsClaims SystemsBenefit Verification Tools
Industry Keywords
MedicareMedicaidPayer ProcessesPharmacy Benefit Manager (PBM)Healthcare Regulations
About the role
Key responsibilities & impact- Serve as a subject matter expert on pharmacy and medical benefit structures for Medicare, Medicaid, and commercial payers
- Interpret coverage and resolve complex benefit questions
- Provide guidance across prior authorization and appeals processes for prescription medications
- Assess eligibility for copay and financial assistance and connect patients with third-party assistance
- Interpret PBM regulations, policies, and industry developments
- Assess benefit, coverage, and authorization questions and determine resolution strategies
- Own cases end to end, resolving issues and escalating when warranted
- Counsel members and patients on coverage, benefits, and financial assistance options
- Partner with members, providers, pharmacies, and other stakeholders to remove barriers to care
- Analyze claims against benefit guidelines and determine corrective action
- Conduct benefit verification and test claims
- Maintain accurate case documentation and decision rationales
- Evaluate quality, identify trends, and recommend process improvements
Requirements
What you’ll need- 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 proven experience in pharmacy benefits, managed care, or patient advocacy within a healthcare or PBM setting, including roles requiring independent judgment and decision-making
- Strong knowledge of pharmacy and medical benefit structures, prior authorization and appeals, healthcare regulations, and payer/insurance processes
- Excellent communication and interpersonal skills, with the ability to translate complex benefit and coverage information into clear guidance for members and providers
- Strong analytical and problem-solving skills, with the ability to interpret claims and benefit information and navigate complex healthcare and payer systems
- A patient-centered approach, with the empathy to support members through difficult or high-stakes situations
- Proficiency with claims, benefit verification, and case management systems, and strong general computer skills
- Strong organizational skills and attention to detail, with the ability to manage multiple priorities and adapt to changing demands
- Ability to work both independently and collaboratively with internal and external stakeholders
- Commitment to maintaining patient confidentiality and adhering to ethical and regulatory standards
- A private, quiet workspace for remote work
Benefits
Comp & perks- Competitive compensation, including health, dental, vision and other benefits
- Opportunity to impact industry change in the pharmacy benefits management space while delivering high-quality patient outcomes
- Culture where people thrive and the business thrives
- Remote work arrangement