Access Specialist

Cycle Pharmaceuticals•Detroit, MI

4d•Remote

About The Position

Cycle Pharmaceuticals is recruiting for an Access Specialist II within our Metabolic team where you'll be supporting our patients and healthcare professionals every step of the way. As an Access Specialist II, you’ll be at the forefront of delivering timely, accurate and compassionate support to both patients and healthcare providers. You’ll be responsible for communicating directly with patients and healthcare professionals to provide benefit summaries, verify insurance coverage, obtain prior authorizations and support appeals processes. As part of your role, you’ll make sure patients are referred to the right resources like educational tools and nursing support to help them feel confident with their care journey.

Requirements

Prior experience within the field of health sciences.
Proven experience in Benefit Investigations and Prior Authorization processes, with a strong understanding of industry documentation standards.
Strong knowledge within Copay and Free Drug Assistance Programs within the Healthcare or Pharmaceutical industry.
Proficient in using CRM systems (Customer relationship management) such as SalesForce, Veeva or Microsoft Dynamics.
Familiar with operating in highly regulated environments, ensuring full compliance with industry policies and procedures.
Prior reimbursement experience with ability to communicate complex reimbursement scenarios to patients and medical professionals.
Strong background in case management and coordinating with patient support services.
Excellent organizational skills with the ability to plan, prioritize and meet deadlines effectively.
Positive, relationship-focused mindset, with strong interpersonal and communication skills.

Nice To Haves

Experienced in working in biotech/pharmaceutical industry for a drug manufacturer or Hub Services provider
Rare disease experience

Responsibilities

Obtain insurance verification and benefits from insurance companies and leveraging additional sources such as insurance carrier websites.
Ensure that all documents and information are up to date and correct in the system.
Prepare benefit summaries and deliver this information to Health Care Professionals and Patients via phone, fax, email, and letters.
Educate Health Care Providers and Staff regarding prior authorization and appeals process & documentation including highly specific, payer-based requirements.
Supply all necessary prior authorization requirements to Health Care Professionals based on the insurance company’s requirements, following Cycle Pharma’s Compliance SOPs and regulatory guidance.
Support patient’s needs for alternate funding scenarios including free drug and copay and enrolling appropriate patients.
Triage orders to Specialty Pharmacies including follow-up calls/emails to gain knowledge of the status of those orders.
Assist with answering any incoming telephone calls or emails within the shared inbox.
Build strong, collaborative relationships with patients, caregivers, insurers, and colleagues to promote service excellence and teamwork at Cycle Pharma.
Work closely with the Clinical Education Managers and support with any other duties as required