Insurance Navigation Expert
2 weeks ago
This role is designed to facilitate patient access to essential medications and therapies. The Patient Access Specialist collaborates closely with healthcare providers and insurance entities to collect vital information regarding patient insurance coverage for specific pharmaceutical products.
Key Responsibilities:
1. Assist patients in obtaining the medications they require by navigating the complexities of insurance coverage.
2. Provide support for healthcare professionals by addressing inquiries related to coding, billing, and reimbursement challenges.
3. Manage prior authorization requests for an assigned caseload and guide patients through the appeals process when necessary.
Job Duties:
- Ensure timely progression of cases through the necessary processes.
- Conduct benefit investigations by contacting payors to verify insurance details and identify any reimbursement barriers.
- Document patient-specific benefits, including coverage and cost-sharing options.
- Identify coverage restrictions and expedite access to medications as needed.
- Initiate prior authorization processes and manage claims appeals.
- Report any trends or delays in reimbursement to management.
- Communicate findings from benefit investigations to healthcare providers and patients promptly and accurately.
Qualifications:
- A background in pharmacy, call center operations, or medical office experience is preferred.
- Familiarity with enrollment, pre-assessment, and benefits processes.
- Strong verbal communication skills and proficiency in grammar.
- Competence in computer usage and software applications.
Education:
- Minimum requirement: High School Diploma; preferred: Associate or Bachelor's degree in Science, Finance, or Business.
- 3 to 5 years of experience in benefit investigation and interaction with healthcare providers regarding health insurance plans.
Preferred Experience:
- 2 to 3 years in claims processing, health insurance benefits, or healthcare billing.
- Experience with Salesforce systems is a plus.
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