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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, prior authorization processes, and patient advocacy within healthcare settings. Proficient in analyzing claims, managing cases, and collaborating with stakeholders to enhance patient care and resolve complex benefit issues.
Highest-signal resume keywords
Pharmacy Benefits ExpertisePrior Authorization ProcessesClaims AnalysisPatient AdvocacyHealthcare Regulations Knowledge
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 ManagementDecision-MakingAnalytical SkillsProblem-SolvingHealthcare RegulationsPayer ProcessesCase Management SystemsDocumentationFinancial Assistance Assessment
Soft Skills
Communication SkillsInterpersonal SkillsOrganizational SkillsEmpathyAttention to Detail
Tools & Technologies
Case Management SystemsClaims SystemsBenefit Verification ToolsGeneral Computer Skills
Industry Keywords
MedicareMedicaidPBM RegulationsManaged CarePatient Confidentiality
About the role
Key responsibilities & impact- Serve as a subject matter expert on pharmacy and medical benefit structures for Medicare, Medicaid, and commercial payers
- Guide patients and providers through prescription medication prior authorization and appeals processes
- Assess eligibility for copay and financial assistance and connect patients with third-party resources
- Interpret PBM regulations, policies, and industry developments
- Assess complex benefit, coverage, and authorization questions and communicate resolution guidance
- Own cases end to end, resolving issues and escalating when warranted
- Counsel members and patients on coverage, benefits, and financial assistance options
- Collaborate with members, providers, pharmacies, and community-based resources 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 rationale
- Evaluate quality, identify trends, and recommend process improvements
Requirements
What you’ll need- Must reside in the state of Washington or Oregon
- 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 ability to translate complex benefit and coverage information into clear guidance
- Strong analytical and problem-solving skills, including interpreting claims and benefit information and navigating complex healthcare and payer systems
- Patient-centered approach and empathy for difficult or high-stakes situations
- Proficiency with claims, benefit verification, and case management systems, plus strong general computer skills
- Strong organizational skills and attention to detail; ability to manage multiple priorities and adapt to changing demands
- Ability to work independently and collaboratively with internal and external stakeholders
- Commitment to patient confidentiality and ethical and regulatory standards
- 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