2 Openings

The Patient Access Specialist is responsible for supporting our client’s reimbursement needs to facilitate patient access to their technologies and procedures. This position will support a variety of key economic stakeholders including client company representatives and their customers including physicians, billing and coding personnel, hospitals, and ambulatory surgical centers. This position will be accountable to serve as a resource in patient access services including, benefits verification, prior authorization, pre-service appeals and post service claims appeals.

Key Responsibilities:

Manage a case load for an assigned program
- Data entry and review of new patient cases into system database
- Communicate with physician’s office and their staff regularly
- Maintain accurate and up-to-date records within the salesforce platform to ensure accurate reporting to clients.
- Complete full patient access process as outlined by program SOP including but not limited to:
  - With Assistance from the Executive Lead, Analyze and interpret patient clinical data, clinical notes and files to determine medical necessity criteria is met specific to each payer policy
  - With assistance from the Executive Lead, Review multiple insurance policies to define medical necessity criteria to support medical device/procedure(s)
  - Benefits verification and payer discovery
  - Prior Authorization/ Pre- service review submissions, pre and post service appeal submissions
  - Ensure all documents developed to support an appeal are accurate, consistent, up to date, and in compliance with applicable Standard Operating Procedures, guidelines, and regulations.
- Ensure compliance with all regulatory and company policies.

KPIs

Established based on the program complexity and align with program success
- Once KPIs are established they are measured daily, weekly and monthly

Qualifications:

High school diploma or equivalent; Associate’s degree preferred.
Minimum of 2 years of experience in a healthcare setting, preferably in authorization or billing.
Understanding of medical terminology and insurance processes.
Excellent communication and organizational skills.
Ability to work independently and handle multiple tasks.

PRIA Healthcare Management LLC remote jobs

PAS - Executive Lead

Patient Access Specialist (2 openings)

Patient Access Specialist – Medical Necessity Investigation