Job Description :
The purpose of this position is to help patients get access to the medications and therapies that they need. This role works with healthcare providers patients payors and pharmacies to gather information about a patient s insurance policy and the coverage provided by that policy for a specific pharmaceutical product.
This position provides access and affordability services for an assigned caseload and helps healthcare professionals and patients navigate any challenges the patient will face to access medications.
The work of the Patient Access Specialist helps make therapies more affordable for patients and gets patients on therapies faster.
Provide daytoday oversight for caseload to ensure all cases and tasks are completed in a timely manner.
Shifts Available :
MF 8am5pm (1 hour lunch)
MF 9am6pm (1 hour lunch)
MF 10am7pm (1 hour lunch)
Training : MF 8 : 30am4 : 30pm CST for 4 weeks. 1 hour paid lunch break during training (this is an 8 hour day they don t clock out during meal break)
1 hour paid lunch break for the three weeks of training (this is an 8 hour day you do not clock out during meal break)
Major duties and responsibilities that are critical and necessary for this position and its overall objective :
Ensure cases move through the process as required
Conduct benefit investigations for patients by making outbound phone call to payors 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
Assign appropriate cost sharing solutions or assess and refer the patient to any special programs / services (as appropriate)
Communicate the results of benefit investigations for patients to healthcare providers and patients in a timely manner and accurately
Requirements
Education required : High School Diploma
High School Diploma
Education preferred :
Associate s or Bachelor s Degree in Science Finance or Business
Years of experience required :
3 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 regards to health insurance plan requirement
Pharmacy background / call center or MD office experience preferred
Exposure to enrollment preassessment & benefits processes
Excellent verbal communication skills and grammar
Computer literacy / competence
Specific type of experience preferred :
2 to 3 years of claims health insurance benefits or health care billing experience.
SalesForce system experience.
Great customer service Capable and able to work overnight shifts
Education
HS Diploma or equivalent
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