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Patient Access Specialist
2 weeks ago
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 healthcare providers by 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.
Responsibilities include:
Ensuring cases move through the process in compliance with company standards and procedures, providing the best service and quality.
Conducting benefit investigations by making outbound calls to payers to verify insurance benefits, navigate reimbursement barriers, and seek resources to overcome these barriers.
Verifying patient-specific benefits, including coverage, cost share, and access/provider options.
Identifying coverage restrictions and ways to expedite patient access.
Documenting and initiating the prior authorization process and claims appeals.
Reporting reimbursement trends or delays to management.
Acting as a liaison for field representatives, healthcare providers, and patients.
Having in-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage.
Possessing 2-3 years of benefit investigation experience involving insurance coverage analysis and interpretation.
Having 2-3 years of experience interacting with healthcare providers regarding health insurance requirements.
Exhibiting excellent verbal communication skills and grammar.
Experience with Salesforce system is preferred.
Competencies include:
Adaptability, Punctuality, Customer Service, Ethics, Interpersonal Skills, Oral Communication, Organizational Support, Professionalism, Quality, Teamwork.
AssistRx is recognized as a top workplace in Orlando for three consecutive years.
We believe access to specialty therapies transforms lives, achieved through our talented team and innovative technology.
Join us to help revolutionize healthcare by improving patient access to medications.
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