Operations Director, SPBM
Microsoft 365
Patient Care Advocate, English/Spanish Bilingual
AffirmedRx, a Public Benefit Corporation
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Serve as a liaison between patients and healthcare providers, ensuring members receive high-level care and support
- Advocate for patients' needs, provide education and guidance, and assist with navigating the healthcare system and pharmacy benefits
- Maintain knowledge and proficiency in pharmacy and medical benefit structures across payer types including Medicare, Medicaid, and commercial
- Be proficient in prior authorization and appeals processes for prescription medications
- Remain current with copay assistance eligibility and PBM regulations, policies, and industry trends
- Serve as direct member and provider contact for pharmacy benefit information and navigation support via telephone, chat, fax, email, or written correspondence
- Handle calls and correspondence from providers and members and resolve issues through follow-through and problem resolution
- Educate members and patients about coverage, benefits, and financial assistance programs and assist enrolling into third-party assistance when applicable
- Collaborate with internal and external stakeholders including members, providers, and pharmacies and leverage community-based resources
- Review claims for accuracy against benefit guidelines and contract standards and complete test claims or electronic verification when applicable
- Document all interactions professionally within specified timeframes and assist in meeting operating and productivity standards, including quality reviews
Requirements
- 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
- English/Spanish bilingual (title indicates bilingual requirement)
