Patient Access Specialist

McKesson•Cary, NC

About The Position

The Patient Access Specialist at Biologics, Inc. plays a vital role in ensuring a positive and efficient experience for our patients. This position is responsible for managing the initial patient intake process, facilitating communication, and ensuring accurate and timely information exchange.

Requirements

High school diploma or equivalent (Associate’s or Bachelor’s preferred).
Experience in healthcare, pharmacy operations, patient access services, reimbursement, or medical benefits.
Strong understanding of commercial, Medicare, and Medicaid insurance plans.
Excellent written and verbal communication skills.
Attention to detail and accuracy.
Strong problem-solving and critical-thinking skills.
Compassionate, patient-centered communication style.
Ability to prioritize in a fast-paced, dynamic environment.
Team-oriented mindset with flexibility to support shifting business needs.

Nice To Haves

Prior experience with specialty or biologic medications.
Familiarity with prior authorization processes, coding (ICD-10, HCPCS, J-codes), and reimbursement workflows.
Experience using Caretend, AssistPoint, or similar case management systems.

Responsibilities

Conduct comprehensive benefit investigations for biologic and specialty therapies.
Verify insurance eligibility, coverage limitations, deductible/co-pay amounts, and specialty pharmacy requirements.
Identify prior authorization, step therapy, quantity limit, or reauthorization needs.
Gather clinical documentation required for prior authorization submissions.
Communicate PA criteria, required forms, and next steps to providers.
Track PA status closely and provide timely updates.
Assist with written or verbal appeals when coverage is denied.
Screen patients for co-pay assistance, foundation grants, or manufacturer sponsored programs.
Help patients complete required paperwork and follow up on application status.
Work closely with internal and external stakeholders to ensure funding alignment with payer requirements.
Provide clear, compassionate communication about coverage status, delays, or next steps.
Educate patients on therapy onboarding, timelines, and support program resources.
Manage inbound and outbound calls with professionalism, accuracy, and empathy.
Collaborate with provider offices to obtain missing documentation, signatures, or clinical details.
Communicate with specialty pharmacies regarding prescriptions, triage steps, and authorizations.
Ensure complete, accurate information flows between all parties to avoid delays.
Maintain detailed, accurate progress notes in Caretend/AssistPoint or other system platforms.
Adhere to HIPAA guidelines and internal compliance standards.
Track and document all steps to support audits, URAC requirements, and internal QA expectations.
Meet productivity and quality benchmarks, including: Turnaround times for BVs and PAs, Quality audit standards, Call handling metrics (when applicable).
Support cross-functional teams as needed based on business workload and service level needs.