Job Description
AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. Join us in improving health care outcomes for all!
We promise to do what's right, always. Position Summary: The Patient Care Advocate (PCA) is responsible for serving as a liaison between patients and healthcare providers, ensuring that members receive the highest level of care and support. While providing best in class service, the PCA will advocate for patient's needs, provide education and guidance, and assist with navigating the healthcare system while removing the complexities of the pharmacy benefit. This role requires excellent communication skills, empathy, and the ability to work collaboratively with internal and external stakeholders.
What you will do: - Knowledge:
- Maintain knowledge and proficiency in pharmacy and medical benefit structure of all major payer types including Medicare, Medicaid, and commercial
- Be knowledgeable and proficient in the entire prior authorization and appeals process for prescription medications.
- Remain current with the requirements and eligibility criteria for copay assistance from public, private, and non-profit organizations related to assigned programs to assist customers with enrolling into third party financial assistance opportunities when applicable
- Stay updated on PBM regulations, policies, and industry trends to provide accurate and relevant information to patients
- Engagement and Collaboration:
- Serve as direct member and provider contact for pharmacy benefit information, prior authorization requests, and navigation support. Inquiries may be received by telephone, chat, fax, email, or written correspondence
- Handle calls and correspondence (electronic and written) regarding pharmacy benefit inquiries from providers (pharmacy/physician) and members
- Serve as an advocate through problem resolution and follow through
- Educate members and patients about coverage, benefits, and financial assistance programs
- Collaborate with internal and external stakeholders including members, providers, and pharmacies
- Leverage community-based resources where appropriate
- Monitoring and Quality Assurance:
- Review claims for accuracy against benefit guidelines and contract standards
- Complete test claims or electronic verification of benefits when applicable
- Document all interactions in an appropriate and professional manner within specified timeframes
- Assist in ensuring all operating and productivity standards are met, which may include conducting quality reviews of calls, chats, and documentation notes to identify opportunities for improvement
- Leverage community-based resources where appropriate.
- Perform other duties and projects as assigned
What you need: - Bachelor's degree in a healthcare-related field (preferred) or equivalent work experience
- Proven experience in a customer service or patient advocacy role within a healthcare setting
- Excellent communication and interpersonal skills, with the ability to effectively communicate complex medical information to patients and families
- Strong problem-solving skills and the ability to navigate complex healthcare systems.
- Empathy and compassion for patients, with the ability to provide emotional support during challenging situations
- Knowledge of medical terminology, healthcare regulations, and insurance processes
- Proficient computer skills and the ability to use electronic medical record systems
- Strong organizational skills and attention to detail
- Ability to work collaboratively as part of a team and independently
- Easily adapt to changing priorities and manage multiple tasks simultaneously
- Maintain patient confidentiality and adhere to ethical standards
- Ability to work in a private, quiet workspace for remote work to be performed
What you get: - To impact industry change in the pharmacy benefits management space, while delivering the highest quality patient outcomes.
- To work in a culture where people thrive because when OUR team thrives, OUR business thrives.
- Competitive compensation with health, dental, vision and other benefits.
Note: AffirmedRx is committed to providing equal employment opportunities to all employees and applicants for employment. Remote employees are expected to maintain a professional work environment free of distractions to ensure optimal performance and collaboration.
Job Tags
Contract work, Work experience placement, Remote work,