Senior Pharmacy Patient Advocate

Overview

 

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The Senior Pharmacy Patient Advocate serves as the primary point of contact and dedicated case owner for specialty pharmacy patients from initial enrollment through ongoing therapy adherence. Operating within a patient support services model, this role combines patient advocacy, manual and in-depth benefits verification, prior authorization management, and longitudinal care coordination to ensure patients can access, afford, and remain on their prescribed specialty therapy. The Senior Pharmacy Patient Advocate demonstrates the ability to guide patients and healthcare providers through every stage of the therapy journey, from first contact to long-term adherence, with empathy, urgency, and a strong commitment to accuracy and patient confidentiality.

Responsibilities

KEY RESPONSIBILITIES:

• Patient Enrollment & Onboarding

  • Serve as the first point of contact for inbound patient and healthcare provider calls, accurately identifying needs and routing or resolving accordingly.
  • Review, process, and complete patient enrollment applications and supporting documentation for manufacturer Patient Assistance Programs (PAP) and specialty patient support services programs with a strong sense of urgency.
  • Process enrollment forms and supporting documents for missing, inconsistent, or updatable information; obtain outstanding items through outbound correspondence. Knowledge/ability to leverage internet-based tools/technology to identify missing information prior to outreaching to patients/providers to obtain.
  • Pre-screen and verify patient eligibility based on PAP and other program criteria; communicate eligibility determinations to patients and authorized representatives daily.
  • Verify prescription information prior to processing, including prescriber, patient demographics, medication, dose, quantity, and refill authorization.
  • Notify patients, authorized representatives, healthcare providers of enrollment approvals, denials, and required next steps in a timely and professional manner.
  • Assist with coordination of shipment and medication fulfillment and delivery.
  • Explain program eligibility, services, and enrollment processes clearly to patients, caregivers, authorized representatives, and physician office staff.
  • Prioritize workload to ensure patient enrollments are processed within program-specified timeframes.

   

  Benefits Verification & Payer Management

• Perform comprehensive patient-level benefits verifications across commercial, Medicare (Parts A, B, C, D), Medicaid, and supplemental insurance plans.
• Assess patients’ financial ability to afford therapy and provide hands-on guidance toward appropriate financial assistance programs and coverage options.
• Identify and locate prior authorization (PA) templates per payer-specific requirements; track and follow through on all outstanding PAs to ensure timely coverage.
• Identify and locate prior authorization appeal templates per payer-specific requirements and communicate requirements to healthcare providers. Track and follow through on all outstanding prior authorization appeals to ensure timely coverage.
• Track payer and plan issues by region; identify trends and report changes or systemic issues to management promptly.
• Research insurance options and explain available programs to patients, assisting them in selecting the best available coverage for their situation.

Longitudinal Case Management & Therapy Adherence

• Maintain continuous ownership of each patient case from initial enrollment through active therapy, serving as the primary liaison for all parties — patient, caregiver, prescriber, pharmacy, and payer.
• Conduct proactive outbound calls and correspondence to patients and providers to share enrollment status details and other program related details.
• Update internal case statuses and coordinate with pharmacy partners to ensure accurate, real-time therapy and shipment status.
• Provide patients with order availability, tracking, and shipping information as needed; schedule and coordinate treatment delivery to the patient or healthcare provider.
• Perform problem-solving on refill-related issues, prescription changes (dose, medication, prescriber), and insurance transitions to prevent gaps in therapy.
• Self-audit case activities regularly to identify errors, inefficiencies or adherence risks and correct proactively.

Communication &