Healthcare Insurance Specialist

2 weeks ago

Sydney, New South Wales, Australia beBeePatientAccess Full time $98,765 - $123,456

Job Title: Patient Access Liaison

This role works directly with healthcare providers and insurance payers to gather information about patient coverage for specific pharmaceutical products.

The Patient Access Liaison will support healthcare providers in addressing coding, billing, and complex reimbursement issues.

This position provides support for Prior Authorizations (PA) for an assigned caseload and navigates the appeals process to access medications. Ensure cases move through the process as required, providing the best level of service and quality.

The liaison conducts benefit investigations by making outbound phone calls to payers to verify patient insurance benefits, navigate complex reimbursement barriers, and seek resources to overcome barriers.

Key Responsibilities:

  • Gather patient insurance information and verify coverage
  • Support healthcare providers in navigating coding and billing issues
  • Navigate complex reimbursement barriers and seek resources to resolve them
  • Document specifics including coverage, cost share, and access/provider options
  • Initiate prior authorization process and claims appeals

Requirements:

  • 2-3 years of experience in benefit investigation involving analysis and interpretation of insurance coverage
  • 2-3 years of experience interacting with healthcare providers regarding health insurance plan requirements
  • Excellent verbal communication skills and grammar
  • Salesforce system experience preferred

Competencies:

  • Adaptability: Adapts to changes in the work environment; manages competing demands; changes approach or method to best fit the situation
  • Attendance/Punctuality: Is consistently at work and on time; ensures work responsibilities are covered when absent
  • Customer Service: Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service
  • Ethics: Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and ethically
  • Interpersonal Skills: Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting
  • Oral Communication: Speaks clearly and persuasively in positive or negative situations; listens and gets clarification
  • Organizational Support: Follows policies and procedures; completes administrative tasks correctly and on time
  • Professionalism: Approaches others in a tactful manner; reacts well under pressure; treats others with respect and consideration
  • Quality: Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality
  • Teamwork: Balances team and individual responsibilities; exhibits objectivity and openness to others' views

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