Patient Access Specialist

Job Description

Starts on site but will transition to remote
M-F 9am-6pm, 10am-7pm, 11am-8pm

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 Benefits Manager will support the healthcare providers addressing questions regarding complex reimbursement issues. The Patient Benefits Manager will assist in ensuring prior authorizations, reauthorizations and appeals are obtained timely, as well as ensuring accurate documentation of payer information and patient status. In addition, the Patient Benefits Manager is responsible for completing a pre-screen to determine eligibility for additional services such as injection services, co-pay mitigation, and patient assistance programs (PAP), if applicable.

Responsibilities:
Performs quality checks on cases and report trends to leadership.
Ensure cases move through the process as required in compliance with company requirements and the organization's defined standards and procedures; in a manner that provides the best level of service and quality
Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures.
Troubleshoot complex cases, spanning multiple disease-states, while interfacing with key stakeholders (internal/external) to ensure optimal start to therapy
Report Adverse Drug Events that have been experienced by the patient in accordance pharmaceutical requirements.
Recognize a product quality complaint and forward caller/written information to a manufacturer.
Conduct benefit investigations for patients by making outbound phone call to payers 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

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.