Patient Access Specialist

Key Responsibilities

• Manage a case load for an assigned program
• Data entry and review of new patient cases into system database
• Communicate with physician’s office and their staff regularly
• Maintain accurate and up-to-date records within the salesforce platform to ensure accurate reporting to clients
• Complete full patient access process as outlined by program SOP including but not limited to:
• Analyze and interpret patient clinical data, clinical notes and files to determine medical necessity criteria is met specific to each payer policy
• Review multiple insurance policies to define medical necessity criteria to support medical device/procedure(s)
• Benefits verification and payer discovery
• Prior Authoriation/ Pre- service review submissions, pre and post service appeal submissions
• Ensure all documents developed to support an appeal are accurate, consistent, up to date, and in compliance with applicable Standard Operating Procedures, guidelines, and regulations. Ensure compliance with all regulatory and company policies

Qualifications

• A high school diploma or equivalent; Associate’s degree preferred
• Minimum of 2 years of experience in a healthcare setting, preferably in authorization or billing
• Understanding of medical terminology and insurance processes
• Excellent communication and organizational skills
• Ability to work independently and handle multiple tasks