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House Rx · 4 months ago

Financial Navigator - Pittsburgh, PA

Pittsburgh, PA

Full-time

Onsite

Entry, Mid Level

$25/hr - $32/hr

2+ years exp

House Rx is a company focused on improving access to specialty medications for patients. They are seeking an On-Site Financial Navigator who will act as a liaison between patients, prescribers, pharmaceutical manufacturers, and insurance companies to help resolve financial barriers to treatment and coordinate financial support for specialty pharmacy patients.

Health CareMedical

Responsibilities

Partner with patients and caregivers to understand financial needs and reduce barriers to treatment

Conduct comprehensive financial needs assessments for new and existing specialty pharmacy patients

Assess insurance benefits, out-of-pocket costs, and eligibility for patient assistance programs, copay foundations, and grants

Educate patients on their insurance benefits, including co-pays, deductibles, and out-of-pocket maximums

Assist patients in enrolling in appropriate financial assistance programs (e.g., manufacturer co-pay cards, foundation grants, patient assistance programs) and maintain timely follow-up to ensure continuity of care

Work closely with the prior authorization team to understand insurance denials and develop strategies for appeal

Verify patient insurance coverage and benefits for specialty drugs, identifying potential gaps in coverage

Collaborate with prescribers and their staff to gather necessary documentation for prior authorizations and appeals

Maintain an up-to-date knowledge base of all available manufacturer and non-profit patient assistance programs

Manage patient enrollment and re-enrollment in assistance programs, ensuring all paperwork and deadlines are met

Track and report on the status of patient assistance applications and financial support

Document all patient interactions and financial information accurately in the pharmacy management system and/or electronic health record

Collaborate closely with House Rx operational and clinic teams to ensure patients start and stay on therapy with minimal disruption

Generate reports on financial assistance outcomes, patient savings, and program utilization

Adhere to all HIPAA regulations and maintain patient confidentiality

Collaborate with the pharmacy team, billing department, and clinical staff to ensure a seamless patient experience

Qualification

Patient financial advocacySpecialty pharmacy experienceInsurance authorizationHealthcare experienceFinancial assistance navigationSpecialty medicationsEmpathyCommunication skillsOrganizational skillsProblem-solving skillsTeamworkDetail-orientedInitiativeAdaptability

Required

Bachelor's degree preferred, preferably in a healthcare, finance, or business-related field. An equivalent combination of education and experience may be considered

Minimum of 2-3 years of experience in a healthcare setting, with a strong preference for experience in a specialty pharmacy, hospital, or clinic

Proven experience in patient financial advocacy, medical billing, or insurance authorization

Demonstrated knowledge of the complex landscape of specialty drug funding, including manufacturer co-pay programs and non-profit foundations

Experience navigating specialty medication benefits investigation, prior authorization, and financial assistance

Comfortable engaging with patients, providers, and all members of the care team both in-person and over the phone

Excited about working in a start-up environment and helping to build workflows and processes from the ground up

Highly organized, detail-oriented, and a proactive problem solver interested in positively impacting each patient's pharmacy experience

An initiative taking individual contributor who can also promote teamwork and collaboration amongst colleagues

Strong understanding of health insurance, copay assistance, grants, and patient support programs

Demonstrate empathy and communicate with excellence when working with patients and caregivers

Preferred

Experience in healthcare, pharmacy, patient access, or financial assistance navigation (specialty pharmacy experience strongly preferred)

Proficient in some common pharmacy software systems (QS1, ComputerRx, PioneerRx, WAM, etc). Bonus points if you have worked in EMR systems (EPIC, Cerner, NextGen, etc) or specialty pharmacy systems (Therigy, Asembia1, ScriptMed, etc)

Familiar with specialty medications, including medications used in autoimmune, endocrinology, and oncology. Willingness to learn therapeutic areas you are not familiar with is great