Access Manager – Healthcare Claims, PAs, Reimbursement & Appeals

This is a fully remote position, open to applicants in United States.

📋 Description

• Guide the patient access journey from benefit verification to the initiation of treatment and resolution of claims or reimbursement issues.

• Recognize and tackle barriers to care, including challenges related to coverage, authorization, and reimbursement.

• Oversee comprehensive case activities involving insurance verification and authorization procedures.

• Obtain coverage approval, ensure the right payment channels are in place, and coordinate copay or foundation assistance.

• Focus on insurance approval timelines, patient treatment schedules, and communication with stakeholders.

• Act as the primary point of contact among internal and external teams, clients, providers, payors, facilities, and patients.

• Support various client programs while maintaining operational oversight and delivering consistent quality service.

• Facilitate relationship management and provide education to physicians, office personnel, payors, patients, and clients.

• Collaborate with the FRM Team and other Patient Services functions to synchronize patient access activities.

⛳️ Requirements

• In-depth knowledge and experience within a healthcare environment.

• Strong grasp of biologic and specialty pharmaceutical markets, reimbursement intricacies, and patient access obstacles across various payor landscapes.

• 2–4 years of experience in pharmacy, healthcare settings, and/or insurance with a focus on customer service.

• Expertise in prior authorization and reimbursement situations.

• Proficient in verifying patient benefits and assessing clinical documentation against payor/plan coverage policies and criteria.

• Familiarity with insurance verification, prior authorization, and appeals processes related to coding, coverage, and payment.

• Excellent documentation, reporting, verbal, and written communication skills.

• Capability to organize, multitask, prioritize tasks, and manage deliverables within set timelines.

• Ability to independently oversee caseloads and address issues effectively.

• Willingness to learn and adopt new processes, systems, and protocols.

• Flexibility to work across Eastern Standard Time to Pacific Standard Time zones.

• A college degree (bachelor’s or associate degree) is preferred.

🏝️ Benefits

• Comprehensive medical, dental, and vision plans.

• Life insurance and disability coverage.

• Tax-advantaged savings accounts.

• Employee Assistance Program.

• Home office benefits.

• Employee Ownership Program.

• Paid time off.

• Paid holidays.

• Bereavement leave.

• 401(k) retirement plan with employer matching.

• Potential eligibility for a performance-based bonus opportunity.