Patient Access Specialist, Full Time- Hybrid/Remote

Vivo Infusion•Lakewood, CO

2d•Remote

About The Position

As the Patient Access Specialist, you will play a crucial role in supporting the Intake Process. You will collaborate with the Revenue Operations Lead and Manager to ensure thorough processing of referrals and patient scheduling. In this position you will also provide excellent customer service, gathering insurance authorizations and eligibility verifications. The individual is responsible for prioritizing, organizing, and completing assigned responsibilities and tasks in a timely manner.

Requirements

2 years of experience working in high-volume insurance verification, benefits, and eligibility/authorizations.
2 years of medical billing and authorizations or managing physician referrals.
1 year experience working in a customer service or patient facing role.
Experience with major medical health insurance benefits verification, prior authorization, and appeals for buy-and-bill infusion therapy and injectable medications strongly preferred.
Minimum 2-3 years of related prior work experience required, preferably in the healthcare industry.
Proven competencies can take precedence over prior work experience.
Knowledge of Medicare & commercial/private insurance benefits, medical authorizations, HIPAA, and medical abbreviations and terminology preferred.
Prior experience working with sensitive information and maintaining confidentiality.
Proficient (intermediate level of application) with all Microsoft Office Products programs.
Must possess outstanding communication and interpersonal skills, be able to communicate professionally and effectively with other staff members, patients, vendors, and physicians, and is fluent in written and spoken English.
Experience supporting multiple managers/supervisors.

Nice To Haves

associate or bachelor’s degree preferred.

Responsibilities

Verify insurance eligibility and benefits for new and existing patients receiving infusion therapy and injectable medications, utilizing payer web portals (e.g., Availity, UHC Provider Portal) and direct payer contact as needed
Coordinate benefits (COB) across primary, secondary, and tertiary payers
Maintain working knowledge of all insurance contracts for assigned clinics and regions
Update patient accounts with current insurance information and ensure records remain accurate and current
Submit prior authorization requests (medical benefits) for infusion therapy via phone, fax, and payer web portals, and follow up to ensure timely determination
Maintain authorization renewals for existing patients to ensure continuity of care
Manage initial insurance denials and appeals specific to infusion therapy, including drafting clinical justification and coordinating with provider offices for supporting documentation
Apply working knowledge of applicable CPT, HCPCS, and ICD-10 codes to authorization submissions
Submit and follow up on PCP referral requests to ensure timely processing and continuity of care
Review, identify, and compile medical records required for benefits verification and authorization
Manage incoming eFax and email correspondence
Ensure referral packets and supporting documentation are scanned and stored in the appropriate EMR location
Document referral progress and account updates in the referral tracking platform
Review and process order updates as they are received
Perform data entry and participate in accuracy audits
Review daily and weekly schedules for insurance eligibility, active authorizations, and current annual financial documents
Identify and resolve issues that could disrupt continuity of care, such as expired authorizations, inactive insurance, or outdated documentation
Demonstrate strong written and verbal communication when interacting with payers, referring office staff, patients, physicians, and internal teams, representing Vivo professionally in every interaction
Coordinate with Clinical Operations and any necessary Patient Services teams – including Patient Care, Medical Policy, Patient Resources, and Specialty Pharmacy coordinators – on referral documentation, COB concerns, patient financial documents, authorizations, and renewals
Use approved templates, naming conventions, formats, and distribution lists for all system notations and email or task communication
Meet departmental productivity, quality, and turnaround time standards as established by Patient Services leadership
Assist with departmental projects as assigned, including account audits, system updates, data entry and reconciliation, acquisition support, and the annual reverification project
Maintain working knowledge of the referral tracking platform and the core EMR
Maintain patient records and confidentiality via the electronic medical record system in accordance with HIPAA guidelines and all applicable Vivo policies
Attend all required meetings related to organizational, departmental, team, and individual performance
Perform other duties as assigned