Financial Navigator - Pittsburgh, PA

House Rx • Pittsburgh, PA

111d • $25 - $32

About The Position

As a pivotal member of the House Rx team, you will work closely with specialty care clinics and the House Rx team to improve the specialty pharmacy experience for specialty patients and their caregivers. This is an onsite role at an office location in Pittsburgh, PA.

Requirements

• Bachelor's degree preferred, preferably in a healthcare, finance, or business-related field.
• 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.
• Familiarity with specialty medications, including medications used in autoimmune, endocrinology, and oncology.
• Strong understanding of health insurance, copay assistance, grants, and patient support programs.

Nice To Haves

• Experience in healthcare, pharmacy, patient access, or financial assistance navigation (specialty pharmacy experience strongly preferred).
• Proficiency in common pharmacy software systems (QS1, ComputerRx, PioneerRx, WAM, etc).
• Experience with EMR systems (EPIC, Cerner, NextGen, etc) or specialty pharmacy systems (Therigy, Asembia1, ScriptMed, etc).
• Highly organized, detail-oriented, and a proactive problem solver.

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.

Benefits

• Paid time off
• Generous parental leave
• Comprehensive healthcare, vision and dental benefits
• Competitive salary and equity stake

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Bachelor's degree
• Number of Employees: 51-100 employees