Senior Pharmacy Patient Advocate
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Pharmacy Patient Advocate based in United States.
This role is a key patient-facing position within a specialty pharmacy support environment, responsible for guiding patients through every step of their treatment journey—from enrollment and benefits verification to ongoing therapy adherence. You will act as a dedicated case owner, ensuring patients, caregivers, and healthcare providers receive timely, accurate, and compassionate support. The role requires close coordination with insurers, pharmacies, and clinical teams to resolve access barriers and maintain continuity of care. You will manage complex, high-volume caseloads while ensuring compliance with strict regulatory standards such as HIPAA. This is a mission-driven position where precision, empathy, and persistence directly impact patients’ ability to access life-changing therapies. You will operate in a fast-paced, structured environment that values accuracy, accountability, and patient-first service.
Accountabilities:
- Serve as the primary point of contact and case owner for patients throughout the full lifecycle of specialty therapy, from enrollment through ongoing adherence.
- Process patient enrollment applications and documentation for specialty pharmacy and patient assistance programs, ensuring accuracy and completeness.
- Verify patient eligibility and benefits across commercial, Medicare, Medicaid, and supplemental insurance plans.
- Conduct detailed benefits verification and financial assessments to support access to appropriate assistance programs.
- Manage prior authorizations and appeals by coordinating with providers and payers to ensure timely therapy approval and coverage.
- Coordinate prescription verification, shipment scheduling, and medication fulfillment with pharmacies and program partners.
- Maintain continuous communication with patients, caregivers, prescribers, and insurers to provide updates on enrollment status, coverage, and therapy progress.
- Track and resolve issues related to prescriptions, insurance changes, refills, and therapy continuity to prevent treatment delays.
- Maintain accurate, compliant, and detailed documentation of all patient interactions within case management systems.
- Monitor caseloads proactively, prioritize tasks, and ensure all cases are resolved within required program timelines.
- Identify and escalate payer trends, systemic issues, and urgent patient concerns when necessary.
- Ensure adherence to HIPAA, regulatory standards, and program-specific requirements, including reporting adverse events or product quality issues.
- Minimum of 5 years of experience in specialty pharmacy, patient support services, or healthcare hub environments.
- Strong experience in benefits verification across commercial and government insurance plans, including Medicare and Medicaid.
- Proven background in prior authorization submission, follow-up, and appeals management.
- High school diploma or equivalent required; associate degree or healthcare-related training preferred.
- Experience working with pharmacy or case management systems in a high-volume, detail-intensive environment.
- Strong understanding of HIPAA regulations and healthcare privacy requirements.
- Excellent communication skills with the ability to interact effectively with patients, providers, and payers.
- High attention to detail with strong organizational and multitasking abilities across complex caseloads.
- Demonstrated empathy, patience, and professionalism when supporting patients in sensitive situations.
- Strong problem-solving skills with the ability to independently resolve issues and manage competing priorities.
- Proficiency in Microsoft Office tools (Word, Excel, Outlook) and related healthcare systems.
- Preferred: pharmacy technician certification (PTCB or ExCPT), bilingual English/Spanish, and experience with platforms such as CoverMyMeds or PrimeRx.
- Competitive hourly compensation ($23–$25/hour) with potential performance-based incentives.
- Comprehensive health, dental, and vision insurance coverage for eligible employees.
- Retirement savings plan options.
- Paid time off and paid parental leave.
- Employee assistance and wellness programs.
- Opportunities for career growth within a specialized healthcare support environment.
- Exposure to patient advocacy work that directly improves access to critical therapies.
- Flexible work arrangements depending on program assignment (remote, hybrid, or onsite).