Patient Access Specialist

2 days ago

Sydney, New South Wales, Australia beBeeInsuranceVerification Full time $80,000 - $120,000

Our organization is dedicated to providing life sciences companies with efficient solutions for patient access, visibility, and outcomes.
We have engineered a perfect blend of technology and talent to support our mission.
As a key member of our team, you will work directly with healthcare providers and insurance plans/payers to gather information about a patient's insurance and the coverage provided for specific pharmaceutical products.
You will support healthcare providers in addressing questions regarding coding and billing, navigating complex reimbursement issues, and ensuring compliance with company requirements and defined standards and procedures.
This role involves conducting 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.
You will identify any coverage restrictions and details on how to expedite patient access, document specifics including coverage, cost share, and access/provider options, and initiate prior authorization processes and claims appeals.
Your in-depth understanding and experience with Buy & Bill, Major Medical & Pharmacy Benefit Coverage will be essential in this role.
The ideal candidate will have 2-5 years of benefit investigation experience involving the analysis and interpretation of insurance coverage, as well as 3-5 years of experience interacting with healthcare providers in regard to health insurance plan requirements.

Key Responsibilities
  • Conduct benefit investigations for patients and communicate results to healthcare providers
  • Navigate complex reimbursement barriers and seek resources to overcome them
  • Document specifics including coverage, cost share, and access/provider options
  • Initiate prior authorization processes and claims appeals
  • Report reimbursement trends or delays in coverage to management
Requirements
  • In-depth understanding and experience with Buy & Bill, Major Medical & Pharmacy Benefit Coverage
  • 2-5 years of benefit investigation experience involving the analysis and interpretation of insurance coverage
  • 3-5 years of experience interacting with healthcare providers in regard to health insurance plan requirements
  • Excellent verbal communication skills and grammar
  • Computer literacy/competence
Benefits
  • Supportive, progressive, fast-paced environment
  • Competitive pay structure
  • Matching 401(k) with immediate vesting
  • Medical, dental, vision, life, and short-term disability insurance

All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors.

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