Patient Access Specialist

AssistRx • Overland Park, KS

1d • Hybrid

About The Position

The purpose of this position is to help patients get access to the medications and therapies that they need. This role works directly with healthcare providers & insurance plans/payers to gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product. The Patient Access Specialist will support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues. This position also provides support for Prior Authorizations (PA) for an assigned caseload and helps navigate the appeals process to access medications. Ensure cases move through the process as required in compliance with company requirements and the organization's defined standards and procedures; in a manner that provides the best level of service and quality. Conduct benefit investigations for patients by making outbound phone call to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers. Verify patient specific benefits and document specifics including coverage, cost share and access/provider options. Identify any coverage restrictions and details on how to expedite patient access. Document and initiate prior authorization process and claims appeals. Report any reimbursement trends or delays in coverage to management.

Requirements

• In-depth understanding and experience with Buy & Bill, Major Medical & Pharmacy Benefit Coverage.
• 2 to 5 years of benefit investigation involving the analysis and interpretation of insurance coverage
• 3 to 5 years of experience interacting with healthcare providers in regard to health insurance plan requirements
• Excellent verbal communication skills and grammar
• Computer literacy/competence
• Salesforce system experience preferred

Responsibilities

• Conduct benefit investigations for patients by making outbound phone call to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers
• Verify patient specific benefits and document specifics including coverage, cost share and access/provider options
• Identify any coverage restrictions and details on how to expedite patient access
• Document and initiate prior authorization process and claims appeals
• Report any reimbursement trends or delays in coverage to management

Benefits

• Preloaded PTO: 100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary.
• Tenure vacation bonus: $1,000 upon 3-year anniversary and $2,500 upon 5-year anniversary.
• Competitive Compensation
• Matching 401(k) with immediate vesting
• Medical, dental, vision, life, & short-term disability insurance
• Referral bonus: $750

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed