Patient Access Specialist - Specialty Pharmacy

About the role

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 the 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 Prior Authorizations (PA) for an assigned caseload and help navigate the appeals process to access medications
• Ensure cases move through the process as required in compliance with company requirements and the organization's defined standards and procedures; in a manner that provides the best level of service and quality
• Conduct benefit investigations for patients by making outbound phone calls to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers
• 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
• Salesforce system experience 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)
• Paid Time off & Holidays: 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

Schedule

Full-time position

Pay

Competitive salary plus benefits