Patient Access Specialist
Job Summary
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 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
- Support healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues
- Support healthcare providers in navigating complex reimbursement barriers and seeking resources to overcome them
- 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 process and claims appeals
- Report any reimbursement trends or delays in coverage to management
- Act as a liaison for field representatives, health care providers and patients
Requirements
- In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage
- 2 to 3 years of benefit investigation involving the analysis and interpretation of insurance coverage
- 2 to 3 years of experience interacting with healthcare providers in regard to health insurance plan requirements
- Excellent verbal communication skills and grammar
- Experience with Salesforce system preferred
Competencies
- Adaptability
- Attendance/Punctuality
- Customer Service
- Interpersonal Skills
- Oral Communication
- Organizational Support
- Professionalism
- Quality
- Teamwork
Benefits
- Voted Top Work Places in Orlando 3 years in a row
- Preloaded PTO: 100 hours (12.5 days)
- Plus 9 paid holidays annually
- Tenure vacation bonus: $1,000 upon 3-year anniversary and $2,500 upon 5-year anniversary
- Full Benefits: Medical, dental, vision, life, & short-term disability insurance, Matching 401(k) with immediate vesting
- Collaborative Environment: Work alongside talented professionals who are dedicated to collaboration, learning, and pushing the boundaries of what's possible
About the Company
Absent any additional details, there are no specific qualifications or requirements for this section. However, the company is described as an Equal Opportunity Employer and emphasizes its commitment to fostering a collaborative and innovative work environment.