Job Details

  • Title: Patient Access Specialist
  • Code: RCI-16455
  • Location: Gaithersburg Maryland (MD) 20878
  • Posted Date: 01/13/2021
  • Duration: 5 Months
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  Job Description

Ideal Candidate Profile:
-Bachelor’s degree OR four years of related work experience
-Customer Service experience/understanding - 1 to 3 yrs (Environments Like: Call center, Dr's Office, Medical Billing Office)
-Reimbursement experience in HUB environment - 1-3 yrs
-Excellent communication skills (verbal/written)


Job Description
The Patient Access Specialist (PAS) will be an essential member of the  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  therapies, including working patient cases that come through  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.

Key Roles/ Responsibilities:
*Manage day to day activities of health care provider support requests and deliverables across multiple communication channels i.e. Phone, Fax, Chat, eMail, etc.
*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 issues
*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:

* Associates Degree or equivalent education in health sciences, managed healthcare, public policy, social work or related disciplines
* 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
* Coordination of patient access experience
* Expert knowledge of specialty products, reimbursement for medical and pharmacy benefits, patient access processes and patient assistance programs: operational policies and processes
* Proven track record for consistently meeting or exceeding qualitative, as well as any relevant quantitative, targets and goals
* Experience with HIPAA policy, patient access data and analytics
* Must be able to support all hours of operations (Hours of operations are 8am-8pm ET)

Preferred:
* Bachelor’s degree, or equivalent education in health sciences, managed healthcare, public policy, social work or related disciplines
* Minimum 3 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
* Relevant biologics healthcare/ insurance experience
* Billing/ Coding background in buy and bill and Specialty Pharmacy markets
Expected Competencies:
* Ability to drive projects and cases to completion, be self-directed, have excellent verbal and written communication skills
* Analytical thinking, problem solving and decision making
* Excellent customer service
* Effective organizational management
* Proficient competency using Word, Excel and PowerPoint
* Ability to multitask and manage multiple parallel projects
* Business acumen; knowledgeable in current and possible future policies, practices, trends, technology and information affecting Access Services programs
Work hours may vary depending on regional alignment to support Health Care Providers
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