Job Details

  • Title: Patient Access Specialist
  • Code: RCI-14013
  • Location: Gaithersburg Maryland (MD) 20878
  • Posted Date: 05/20/2020
  • Duration: 6 Months
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  Job Description

Ideal Candidate Profile:

  • Customer Service experience/understanding - 1 to 3 yrs (Environments Like: Call center, Dr's Office, Medical Billing Office)
  • Bachelor’s degree OR four years of related work experience
  • Reimbursement experience in HUB environment - 1-3 yrs
  • Excellent communication skills (verbal/written)
  • Basic Word (must score 70% or higher to be considered)
The Patient Access Specialist (PAS) will be an essential member of the client Access 360 team. This position will be responsible for addressing all cases including complex reimbursement issues, providing education and information relating to the utilization of available resources to support appropriate patient access to client therapies, including working patient cases that come through client Access 360™ program. This role will focus on identification of access issues and excellent and responsive support providing information and resources to address reimbursement access barriers and maintaining strong internal and external communications.
  • Manage day to day activities of health care provider support requests and deliverables across multiple communication channels i.e. Phone, Fax, Chat, eMail
  • Perform intake of cases and capture all relevant information in the Access 360 Case Management system
  • Ensure all support requested is captured within the Case Management system
  • Ensure timely processing and resolution of cases
  • Escalate cases appropriately to the Patient Access Associate team
  • Coordinate all appropriate aspects of patient case management through to completion, using effective interpersonal skills to manage interactions
  • Serve as a resource for Health Care Providers and patients and use regional reimbursement, distribution and payer policy expertise to provide solutions for complex patient access situations, working closely with the PAA team to appropriately escalate/resolve issue
  • Communicate effectively with payers, third party administrators and other departments
  • Perform in-depth research into patient’s insurance, prior authorization and appeal requests on behalf of the provider
  • Educate offices on Access 360 programs and referral process to ensure timely case processing
Minimum Requirements:
  • Experience with HIPAA policy, patient access data and analytics
  • Expert knowledge of specialty products, reimbursement for medical and pharmacy benefits, patient access processes and patient assistance programs: operational policies and processes
  • Minimum 2 years of healthcare/healthcare reimbursement experience; high level of proficiency in all aspects of reimbursement and access, i.e., benefit investigations, specialty pharmacy distribution, private and public payer reimbursement policies and procedures, regulatory and administrative rules
  • Associates Degree or equivalent education in health sciences, managed healthcare, public policy, social work or related disciplines
  • Coordination of patient access experience
  • Proven track record for consistently meeting or exceeding qualitative, as well as any relevant quantitative, targets and goals
  • Must be able to support all hours of operations (Hours of operations are 8am-8pm ET)