Patient Access Specialist

Walgreens•Pittsburgh, PA

About The Position

The Patient Access Specialist oversees patients’ financial journeys, including benefits investigation, prior authorization support, and enrollment in financial assistance programs. The role manages inbound and outbound communication with patients, prescriber offices, and third-party providers to clarify medical and pharmacy coverage, benefits, and related inquiries, with an emphasis on efficient, courteous, patient-centered support. The specialist resolves complex insurance rejections; initiates, reviews, submits, tracks, and follows up on prior authorizations, appeals, and medical tier exceptions; and coordinates enrollment in manufacturer-sponsored assistance programs and other financial support resources. The position serves as a liaison among patients, healthcare providers, insurance companies, and program sponsors to support accurate documentation and timely processing. Walgreens, founded in 1901, serves nearly 9 million customers and patients each day across approximately 8,500 stores in the U.S. and Puerto Rico. It has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and describes its commitment as building trusted relationships that create healthier futures for customers, patients, team members, and communities.

Requirements

High school diploma from an accredited school or equivalent GED.
At least 1 year of work experience in healthcare, specialty pharmacy, PBM, and/or call center settings.
Experience providing customer service to internal and external customers and meeting service quality standards, including in healthcare, specialty pharmacy, PBM, call center, or a related industry.
Clear and effective written and verbal communication skills.
Good interpersonal skills and the ability to communicate diplomatically and confidentially.
Basic PC skills, including use of MS Windows, MS Office Suite, or similar operating software.
Experience identifying operational issues and recommending and implementing strategies to resolve problems.
Familiarity with medical terminology, prescriptions, and pharmacy regulations.
Intermediate PC skills, including use of MS Windows, MS Office Suite, or similar operating software.

Responsibilities

Confirm pharmacy and medical coverage, including eligibility, co-pays, deductibles, secondary insurance, and network status.
Identify and explain available financial assistance programs.
Initiate, complete, and track prior authorizations, medical tier exceptions, and appeals.
Prepare documentation, collaborate with providers and payors, and meet approval and denial timelines.
Submit accurate reimbursement claims and resolve non-clinical payor rejections and benefit discrepancies.
Collect and submit documentation for copay cards, patient assistance, and other support programs.
Monitor program renewals, educate patients and providers on eligibility, and resolve delays or denials.
Liaise among patients, providers, and payors to clarify benefits, coverage, and next steps.
Provide empathetic, patient-centered support to people navigating financial or medical challenges.
Maintain accurate records of interactions, outcomes, and program details.
Escalate complex cases to management or program sponsors as needed.
Escalate concerns about adverse events and product quality to the clinical team.
Ensure compliance with HIPAA regulations and organizational policies.
Cross-train and support other key organizational functions as needed.
Participate in post-onboarding training and development to enhance skills and performance.