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Patient Access Specialist

2 months ago

Atlanta, United States Spectraforce Technologies Full time

Title: Patient Access Specialist
Location: Remote
Duration: 3+ month’s
Shift timings: 8:00 am - 8:00 pm EST

Job Details:

  • Complete data entry from the enrollment form into the CRM.
  • Complete electronic eligibility checks for payer and coverage details.
  • Conduct a benefit investigation to determine plan coverage, payer restrictions, and cost share information from insurance plans.
  • Identify if coverage restrictions exist, the process in which they are handled.
  • Collect PA requirements, follow up with the insurance for prior authorization status, and communicate the results to the healthcare provider.
  • Conduct follow up outreach to healthcare providers to collect information needed to evaluate for services.
  • Evaluate patient records against eligibility criteria to determine if they can continue free drug assistance.

Position Summary:
Under the general supervision of an Operations Manager, the Customer Access Specialist will be providing advanced services to patients, providers, and caregivers on behalf of patients for a specific manufacturer sponsored program or set of programs.

Primary Duties and Responsibilities:

  1. Provides advanced services to patients, providers, and caregivers. Services could include but not limited:
  1. Billing and coding support.
  2. Claims assistance, tracking and submission.
  3. Prior authorization assistance and tracking.
  4. Coordination of benefits.
  5. Benefit verification result call.
  6. Welcome calls.
  7. Advanced alternate coverage research.
  8. Appeals/Denials.
  9. Intakes and reports adverse events as directed.
  1. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
  2. Establishes themselves as regional experts regarding payer trends and reports any reimbursement trends/delays to management team (e.g. billing denials, claim denials, pricing errors, payments, etc.).
  3. Processes any necessary correspondence.
  4. Coordinates with internal and external service providers to ensure services are performed in accordance with program policy and within expected service level agreements (SLA).
  5. Maintains confidentiality in regard to all patient sensitive information.
  6. Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.
  7. Required to be self-motivated, working from a queue (phone or system). Expected to perform work in accordance with defined standard operating procedures. Management will monitor queues and provide active feedback as required.
  8. Performs related duties as assigned, could include well defined services generally performed by other program representatives (e.g., benefit verifications, PAP determinations).


Experience and Educational Requirements:
High school diploma or GED required. Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, customer service or similar vocations generally obtained through completion of a two-year associate degree program, technical vocational training, or equivalent combination of experience and education. Four years (4) + years directly related and progressively responsible experience required. A two-year degree can be used in lieu of 2 years of the experience requirement, a four-year degree in lieu of 4 years of experience.

Minimum Skills, Knowledge and Ability Requirements:

  1. Ability to communicate effectively both orally and in writing.
  2. Ability to build productive internal/external working relationships.
  3. Advanced interpersonal skills.
  4. Strong mathematical skills.
  5. Basic analytical skills.
  6. Advanced organizational skills and attention to detail.
  7. General knowledge of accounting principles, pharmacy operations, and medical claims.
  8. Acceptable use of medical industry vernacular.
  9. General knowledge of health care billing preferred.
  10. Ability to proficiently use Microsoft Excel, Outlook, and Word.
  11. Developing professional expertise; applies company policies and procedures to resolve a variety of issues.


Work Environment:

  • The work environment characteristics described here are representative of those an associate encounter while performing the essential functions of this job.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions: The noise level in the work environment is consistent with an office setting.