Patient Access Specialist

***VOTED BEST PLACES TO WORK two years in a row***

• Compensation: $20/hr
  
• Work from home: The opportunity to work from home will be made available after 120 days upon goals and quotas being met at the discretion of the manager.
  

Why Choose Us:

• Impactful Work: Join a team that is at the forefront of revolutionizing healthcare by improving patient access to essential medications.
  
• Flexible Culture: Many associates earn the opportunity to work from home after 120 days. Enjoy a flexible and inclusive work culture that values work-life balance and diverse perspectives.
  
• Career Growth: We prioritize a “promote from within mentality”. We invest in our employees' growth and development via our Advance Gold program, offering opportunities to expand skill sets and advance within the organization.
  
• Innovation: Contribute to the development of groundbreaking solutions that address complex challenges in the healthcare industry.
  
• Collaborative Environment: Work alongside talented professionals who are dedicated to collaboration, learning, and pushing the boundaries of what's possible.
  

The purpose of this position is to help patients get access to the medications and therapies that they need. This role works directly with healthcare providers & insurance plans/payers to gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product. The Patient Access Specialist will support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues. This position also provides support for Prior Authorizations (PA) for an assigned caseload and helps navigate the appeals process to access medications.

• Ensure cases move through the process as required in compliance with company requirements and the organization's defined standards and procedures; in a manner that provides the best level of service and quality
  
• Conduct benefit investigations for patients by making outbound phone call to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers
  
• Verify patient specific benefits and document specifics including coverage, cost share and access/provider options
  
• Identify any coverage restrictions and details on how to expedite patient access
  
• Document and initiate prior authorization process and claims appeals
  
• Report any reimbursement trends or delays in coverage to management
  

Requirements

• In-depth understanding and experience with Buy & Bill, Major Medical & Pharmacy Benefit Coverage.
  
• 2 to 5 years of benefit investigation involving the analysis and interpretation of insurance coverage
  
• 3 to 5 years of experience interacting with healthcare providers in regard to health insurance plan requirements
  
• Excellent verbal communication skills and grammar
  
• Computer literacy/competence
  
• Salesforce system experience preferred
  

Benefits

• Supportive, progressive, fast-paced environment
  
• Competitive pay structure
  
• Matching 401(k) with immediate vesting
  
• Medical, dental, vision, life, & short-term disability insurance