Client Advocate

Navitus Health Solutions, LLC

1d•Remote

About The Position

Navitus Health Solutions is seeking a Client Advocate to join our team! The Client Advocate (CA) acts as a hybrid of Account Representative and Case Manager to advocate on behalf of the client’s pharmacy benefit program. The CA will field inbound escalation requests from client representatives such as benefit professionals or health care facilitators to assist with escalated member research cases. The CA will collect relevant information and work across the Navitus organization to identify, understand, and determine next steps for resolution. The CA may make outbound communications to members, prescribers and/or pharmacies to complete the research cycle and assist the client’s members in understanding those next steps and provide white glove member service. The CA should be comfortable researching across departments on a multitude of topics, including, but not limited to, coverage determinations, manual claim submissions, recoveries, transition status, and overall claims adjudication results. The CA will become proficient in the Navitus claims processing system and Intranet. The CA will gain proficiency in understanding, applying, and communicating client-specific formularies, clinical programs, and other pharmacy benefit components. The position may be located in one of our offices in Appleton (WI), Madison (WI), Phoenix (AZ), hybrid, or fully remote. Is this you? Find out more below!

Requirements

A minimum of a high school degree or equivalent is required
5+ Years’ previous experience working with members/patients
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees

Nice To Haves

National Certification from an accredited pharmacy technician certification program approved by specific state regulations (e.g. PTCB, ExCPT, CPhT etc.). or Licensed Practical Nurse (LPN) degree or certificate preferred
Experience in a mail pharmacy, retail pharmacy or clinic/care setting desired
Experience as a member of a multi-disciplinary team is preferred
Knowledge of applicable data privacy practices and laws is preferred

Responsibilities

Field inbound inquiries from benefit professionals, health care facilitators as a member of the broader client account team
Research and analyze electronic and manual claims. Apply troubleshooting skills to resolve issues as allowed by the individual benefit, including entering and updating MPAs and submitting test claims
Communicate prior authorization, exception, and appeals information to callers including required information, turn-around-times, and other applicable details
Help educate, when appropriate, members how to navigate their benefit, including information regarding participating pharmacies, best utilization of their benefit, formulary explanations, patient pay amounts, benefit restrictions, and other information as applicable
Documents and tracks status of inquiries and resolution in both NCRx and CRM
Respond to and resolve all internal and external inquiries in a timely, accurate, and complete manner
Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements
Other duties as assigned