Patient Access Advocate in at Regalo Health LLC

Position Summary

The Patient Access Advocate supports patients, caregivers, healthcare providers, pharmacies, and payers participating in an oncology patient support program. This role helps patients access prescribed therapy by coordinating insurance benefits, prior authorizations, appeals, financial assistance, and specialty pharmacy services.

The ideal candidate brings pharmaceutical HUB, specialty pharmacy, reimbursement, or patient access experience and is comfortable managing complex cases in a fast-paced, highly regulated environment.

Key Responsibilities

• Serve as a primary point of contact for patients, caregivers, healthcare providers, payers, and pharmacies.
• Conduct insurance benefit investigations and verify medical and pharmacy coverage.
• Identify formulary restrictions, prior authorization requirements, and other access barriers.
• Coordinate prior authorization submissions and follow up with providers and payers through determination.
• Support appeals and denial resolution, including obtaining required documentation and tracking deadlines.
• Assist patients with financial assistance and Patient Assistance Program eligibility and enrollment.
• Coordinate prescriptions with specialty pharmacies and other dispensing partners to support timely therapy initiation.
• Maintain accurate and timely patient case documentation within the program's CRM/case management system.
• Provide ongoing case-status updates to patients and healthcare providers.
• Follow approved program scripts, workflows, SOPs, privacy requirements, and service standards.
• Identify and immediately escalate potential adverse events and product quality complaints according to established procedures.
• Participate in program training, quality reviews, and ongoing process improvement.

Qualifications

• 3+ years of healthcare patient services, patient access, reimbursement, specialty pharmacy, or pharmaceutical HUB experience.
• Direct experience with benefit investigations and prior authorizations required.
• Working knowledge of commercial insurance, Medicare, and Medicaid.
• Experience with appeals, denials, Patient Assistance Programs, copay assistance, and specialty pharmacy coordination preferred.
• Pharmaceutical HUB or specialty patient services experience strongly preferred.
• Oncology experience is a plus, but strong HUB/reimbursement experience is more important.
• Bachelor's degree preferred; equivalent relevant healthcare experience will be considered.

Skills

• Strong understanding of healthcare reimbursement and patient access processes.
• Excellent verbal and written communication skills.
• Ability to explain complex insurance information clearly and compassionately.
• Strong case-management, organizational, and follow-up skills.
• High attention to detail and documentation accuracy.
• Ability to manage multiple time-sensitive patient cases simultaneously.
• Comfortable working in CRM and case-management systems.
• Strong commitment to privacy, compliance, quality, and patient experience.

What Success Looks Like

Success in this role is measured by accurate case management, timely resolution of access barriers, quality documentation, responsiveness, compliance, and patient/provider experience, with a focus on helping patients move toward therapy as efficiently as possible.