Patient Access Specialist

About the role

The Patient Access Specialist, Rare/Orphan will be responsible for benefits investigation, prior authorization support, and claims adjudication, as well as refill management and delivery coordination functions in accordance with company policies and procedures.

Responsibilities

• Locate and enter accurate prescription insurance information on patient’s profile by processing eligibility checks and adjudicating pharmacy claims.
• Adjudicate claims and troubleshoot rejections so that the correct information is communicated to the patient.
• Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process.
• Manage inbound calls from patients, clients, physicians, practitioners and clinics regarding inquiries about order status, services provided, financial support options.
• Serve as a technical resource pertaining to adjudication while identifying areas for improvement.
• Entering detailed, accurate, and grammatically correct progress notes to ensure proper documentation on patient profiles.
• Contact patients to schedule medication delivery and payment so that accurate information is included in their profile and distribution can successfully send their package in a timely manner.
• Manage patient refill coordination and follow-up to ensure patients comply with their therapy plan.
• Identify and report adverse events (AEs) and product complaints (PCs) to clinicians to ensure patient’s safety.
• Perform other duties as assigned (above tasks may vary slightly depending on the specific team/program requirements).

Requirements

• Typically requires 3+ years of related experience.
• Education: High school diploma required.
• Certification: CPhT (Certified Pharmacy Technician) preferred, not required. Must be current, without restrictions, and in good standing.
• Critical Skills: 3+ years prior experience working in a pharmacy or other health care setting required; experience with insurance eligibility and prior authorization processes; competent in basic computer skills and proficiency in Microsoft applications; conscientious, detail oriented with the ability and desire to solve problems to help our patients; flexible, adaptable, and the ability to effectively work in a team setting to accomplish a common goal; highly motivated and committed to excellence with a positive attitude.