Patient Access Specialist, HUB

Walgreens•Pittsburgh, PA

About The Position

Job Summary: The Patient Access Specialist oversees the patient’s coverage journey from start to finish, including benefits investigation, prior authorization support, and enrollment in financial assistance programs. This role manages inbound and outbound communication with patients, prescriber offices, and insurance companies to clarify medical and pharmacy coverage, benefits, and related inquiries, ensuring all interactions are handled efficiently and courteously. Key responsibilities include resolving complex insurance rejections that require follow-up with patients, prescribers, and payors; managing the full authorization process—prior authorizations, appeals, and medical tier exceptions—by initiating, reviewing, submitting, tracking, and following up on requests. The specialist coordinates enrollment in manufacturer-sponsored assistance programs and other financial support resources, serving as a liaison between patients, prescribers, insurance companies, and program sponsors to ensure accurate documentation and timely processing.

Requirements

High school diploma or GED.
At least 1 year of experience in patient care, healthcare, retail, or customer service-oriented role.
Experience providing customer service.
Strong written and verbal communication abilities.
Ability to prioritize and manage multiple responsibilities.
Experience developing ways of accomplishing goals with little or no supervision, depending on oneself to complete objectives and determining when escalation of issues is necessary.
Experience providing customer service in a healthcare, specialty pharmacy, PBM, call center setting or other related industry including but not limited to adherence, quality, etc.
Experience in identifying operational issues and recommending and implementing strategies to resolve problems.
Familiarity of medical terminology, prescriptions, and pharmacy regulations.
Intermediate level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line).

Responsibilities

Serves as the single point of contact for manufacturers and third-party HUBs relating to any patient, prescription, program or data query, while ensuring policies and procedures are followed
Coordinates patient care by scheduling referrals communicating shipment information, assessing supply needs, verifying patient information, and triaging patients to a pharmacist, as appropriate.
Creates and processes through all assigned referral and order stages including re-orders received by electronic data feed, fax, mail and telephone
Partner closely with manufacturer/HUB Case Managers to ensure streamlined communication and minimize service interruptions.
May perform Order Processing functions such as data entry, calling doctors’ offices for Rx clarifications and updating patient medical profile.
Performs review of patient financial documents to determine FPL% (Federal Poverty Level percentage) to perform eligibility determination functions.
Creates and distributes daily Bridge Report and Quick Start reports for review of patient eligibility for department Bridge and Quick Start programs, as well as processing through all referral and order stages all Bridge and Quick Start referrals and re-order referrals.
Completes monthly benefit investigation to determine patient's eligibility for patient assistance programs (PAP), including review of patient financial documents.
Consults with the pharmacists to make them aware of any changes in a patient's condition, compliance issues or side effects and transfer patients directly to a pharmacist for counseling, as needed.
Assists with patient activities, including follow-up calls for patient's next order/refill, initiate the discharge of patient from services, contact a patient's doctor's office to schedule delivery of an order, request a letter be sent to the patient if unable to make contact and any other reminders necessary related to the patient's care.
Other responsibilities as judgment or necessity dictate.