Patient Access Liaison - TEPEZZA - Roanoke, VA

Patient Access Liaison

Responsibilities

• Serve as a resource on patient access and reimbursement for infused and specialty therapies.
• Assist patients, caregivers, and healthcare providers in navigating insurance benefits, prior authorization requirements, and reimbursement processes.
• Support the identification and resolution of access challenges, including coverage questions, prior authorization barriers, and denied claims.
• Provide education regarding coding and billing considerations relevant to therapy access.
• Develop relationships with patients and caregivers through phone, virtual, and in-person engagement.
• Secure written or electronic patient HIPAA authorization within assigned geography.
• Assess individual patient needs and provide education and resources that support access to therapy.
• Educate patients on coverage considerations and the steps required to obtain prior authorization.
• Provide information regarding co-pay assistance programs, national foundations, and free drug programs when appropriate.
• Educate physician offices and sites of care on therapy coverage pathways and reimbursement processes.
• Provide information regarding common prior authorization requirements, coding considerations, and billing practices.
• Support healthcare providers and infusion centers in navigating reimbursement questions related to patient cases.
• Investigate patient access challenges before and after infusion.
• Support physician offices and sites of care in reviewing denied claims and identifying potential next steps.
• Escalate complex or systemic reimbursement issues to appropriate internal stakeholders.
• Partner with internal stakeholders including Market Access, Medical Affairs, Advocacy, Case Managers, and Site of Care teams to support patient access initiatives.
• Cross-coordinate with internal and external partners to ensure appropriate resources are available to support patient access.
• Share field insights regarding payer policies and reimbursement challenges.

Requirements

• Doctorate degree OR Masters degree and 2 years of patient services and/or access and reimbursement experience OR Bachelors degree and 4 years of patient services and/or access and reimbursement experience OR Associates degree and 8 years of patient services and/or access and reimbursement experience OR High school diploma/GED and 10 years of patient services and/or access and reimbursement experience

Qualifications

• Experience supporting buy-and-bill or infused pharmaceutical therapies
• Rare disease or orphan drug experience
• Clinical background such as nursing or allied health
• Understanding of reimbursement processes including prior authorization, appeals, and denied claims management
• Knowledge of HIPAA guidelines and FDA regulatory requirements
• Familiarity with internal and OIG compliance guidelines
• Strong analytical and problem-solving skills
• Excellent written and verbal communication skills
• Ability to manage complex patient situations and resolve access barriers
• Experience working in cross-functional field teams
• Proficiency in Microsoft Office, CRM, and relevant systems
• Access and reimbursement knowledge
• Prior authorization processes
• Healthcare reimbursement systems
• Coding and billing awareness
• Patient support program knowledge
• Compliance and privacy requirements
• Learning agility
• Decision quality
• Stakeholder engagement
• Ability to respond rapidly to urgent access needs to prevent treatment delays or lapses
• Ability to operate effectively in matrix field environments
• Travel up to 50%, including occasional overnight and weekend commitments