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.
Title: Patient Access Specialist
Planned Start Date: 08/05/2024
Industry: Specialty Pharmacy Care
Work Location: Orlando, FL (Work Onsite Required)
Pay: Up to $20.00hr Pay
Shift Options: You may select any 2 days off during the week which will remain consistent. The 2 days off must be chosen at the time of the offer acceptance.
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 day-to-day oversight for caseload to ensure all cases and tasks are completed in a timely manner.
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
Job Skills Requirements:
Pharmacy background/call center or MD office experience preferred
Exposure to enrollment, pre-assessment & benefits' processes
Excellent verbal communication skills and grammar
Computer literacy/competence
Education and Experience Requirements:
Minimum High School Diploma Education preferred: Associate 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 regard to health insurance plan
Specific type of experience preferred:
2 to 3 years of claims, health insurance benefits or health care billing experience.
Salesforce system experience.
SRG offers flexible staffing solutions with a national presence. We provide contract, contract-to-hire, direct hire and executive search services. SRG utilizes an innovative approach to identify and qualify talent that is unique to the Staffing industry, featuring a cutting-edge platform that allows us to rapidly and precisely match professionals to client requirements. We have a proprietary database of over one million candidates and maintain continuous contact with our qualified talent.
EOE/AOE
Seniority level
Mid-Senior level
Employment type
Contract
Job function
Health Care Provider
Industries
Staffing and Recruiting
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