Health Services Specialist

McKesson•Cary, NC

1d•$18 - $30•Onsite

About The Position

The Biologics Patient Access Specialist is responsible for coordinating and supporting all aspects of patient access to specialty and biologic therapies. This role serves as a key liaison between patients, providers, payers, specialty pharmacies, and internal teams to ensure timely access to prescribed medications. Responsibilities include benefits investigations, prior authorization support, financial assistance coordination, patient education, and ongoing communication to remove treatment barriers and promote a seamless patient experience.

Requirements

Typically requires 3+ years of related experience.
High school diploma or equivalent required
Experience in healthcare, pharmacy operations, reimbursement support, patient access services, or medical benefits.
Working knowledge of commercial, Medicare, and Medicaid insurance plans.
Strong verbal and written communication skills.
Proficiency with Microsoft Office and healthcare technology platforms.

Nice To Haves

Associate's or Bachelor's degree preferred.
Experience supporting specialty or biologic medications.
Knowledge of prior authorization processes, reimbursement workflows, and medical coding, including ICD-10, HCPCS, and J-codes.
Experience with CareTend, AssistPoint, or comparable patient access management systems.
Familiarity with manufacturer patient support programs and financial assistance resources.

Responsibilities

Conduct comprehensive benefits investigations for specialty and biologic medications.
Verify insurance eligibility, coverage criteria, deductible and copay responsibilities, and specialty pharmacy requirements.
Identify prior authorization, step therapy, quantity limits, and reauthorization requirements.
Communicate coverage determinations and next steps to providers, patients, and internal stakeholders.
Obtain and review clinical documentation necessary for prior authorization submissions.
Educate provider offices on payer requirements, authorization criteria, and required forms.
Track authorization requests and provide timely status updates.
Support the appeals process by gathering documentation and assisting with oral or written appeal submissions when coverage is denied.
Assess patient eligibility for copay assistance programs, manufacturer-sponsored support, and foundation grants.
Assist patients with program enrollment and application completion.
Monitor application status and coordinate funding approvals.
Collaborate with internal and external partners to ensure financial assistance aligns with payer guidelines and program requirements.
Provide compassionate and professional support to patients throughout the treatment access process.
Educate patients on therapy onboarding, expected timelines, and available support resources.
Manage inbound and outbound communications with accuracy, empathy, and professionalism.
Proactively communicate delays, barriers, and resolution plans to patients and stakeholders.
Partner with provider offices to obtain missing documentation, prescriptions, signatures, and clinical information.
Coordinate with specialty pharmacies regarding prescription processing, authorization requirements, and patient onboarding activities.
Facilitate accurate information exchange between all stakeholders to prevent delays in therapy initiation.
Maintain accurate, detailed, and timely documentation in CareTend, AssistPoint, or other case management systems.
Ensure compliance with HIPAA regulations, company policies, and applicable healthcare standards.
Document all patient interactions and case activities to support audits, quality assurance reviews, and URAC accreditation requirements.
Meet established productivity, quality, and service-level standards.
Adhere to turnaround time requirements for benefits investigations, prior authorizations, and case updates.
Maintain quality audit scores and call performance metrics, when applicable.
Support cross-functional teams and assist with workload balancing based on business needs.