Navigating Complex Healthcare Systems Specialist

2 weeks ago

Sydney, New South Wales, Australia beBeePatientAccess Full time $90,000 - $110,000
Job Title: Patient Access Specialist

This role involves direct interaction with healthcare providers and insurance plans/payers to obtain information about patient insurance and coverage for specific pharmaceutical products.

The ideal candidate will support healthcare providers in addressing questions regarding coding and billing, as well as navigate complex reimbursement issues.

This position provides support for Prior Authorizations (PA) for an assigned caseload and assists in navigating the appeals process to access medications. The specialist must ensure cases move through the process as required, in compliance with company requirements and organizational standards.

  • Conduct benefit investigations for patients by making outbound phone calls to payers to verify patient insurance benefit information, navigate complex reimbursement barriers, and seek resources to overcome these 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 processes and claims appeals.
  • Report any reimbursement trends or delays in coverage to management.
  • Act as a liaison for field representatives, healthcare providers, and patients.
Required Skills and Qualifications:
  • 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.
  • Ethics: Treats people with respect; keeps commitments; inspires trust of others.
  • Interpersonal Skills: Focuses on solving conflict, not blaming; maintains confidentiality.
  • Oral Communication: Speaks clearly and persuasively in positive or negative situations.
  • Organizational Support: Follows policies and procedures; completes administrative tasks correctly and on time.
  • Professionalism: Approaches others in a tactful manner; reacts well under pressure.
  • 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.
Benefits:

We prioritize a collaborative environment that allows talented professionals to work together to deliver best-in-class results.

Award-winning culture recognizes employees who transform lives for patients every day.

AssistRx, Inc. is proud to be an Equal Opportunity Employer.

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