Patient Access Consultant

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

📋 Description

• Execute reimbursement tasks, including claim submission and status monitoring, collection efforts, appeals, patient assistance, and copay support.

• Offer billing and coding assistance, claims support, prior authorization help, coordination of benefits, benefit verification calls, welcome calls, and research on alternate coverage.

• Manage appeals and denials, incoming phone queue inquiries, support program decisions, pharmacy triage and coordination, order processing, follow-up activities, intakes, adverse-event reporting as directed, and non-clinical adherence services.

• Collaborate with manufacturer representatives concerning payer profiles, reimbursement trends, and office-specific matters.

• Coordinate services with field reimbursement teams and sales representatives.

• Deliver customer service to both internal and external clients, resolving or escalating requests and complaints as necessary.

• Analyze, report, resolve, and communicate reimbursement patterns and delays.

• Process correspondence and coordinate with both internal and external service providers in accordance with program policies and service-level agreements.

• Support internal associates and manage initial customer escalations.

• Verify transactions and ensure compliance with organizational and departmental policies and procedures; propose changes and solutions.

• Resolve complex accounts independently with minimal oversight.

• Maintain confidentiality regarding patient-sensitive information.

• Analyze intricate issues, exercise judgment in selecting methods and evaluation criteria, and network with contacts outside the immediate area of expertise.

• Determine methods and procedures for new or specialized assignments.

• Carry out related duties and special projects as assigned.

⛳️ Requirements

• High school diploma or GED is required.

• Extensive training in business administration, accounting, computer sciences, medical billing and coding, customer service, or related fields through a two-year associate’s degree program, technical vocational training, or equivalent experience and education combination.

• A minimum of five (5) years of directly relevant and progressively responsible experience is required.

• A two-year degree may substitute for two years of the experience requirement.

• A four-year degree can replace four years of the experience requirement.

• A four-year degree is preferred.

• Strong verbal and written communication skills are essential.

• Ability to cultivate productive working relationships both internally and externally.

• Advanced interpersonal skills are required.

• Strong mathematical abilities.

• Basic analytical skills.

• Exceptional organizational skills and attention to detail.

• Comprehensive understanding of pharmacy operations and medical claims.

• Proficient use of medical industry terminology.

• General knowledge of healthcare billing is required; advanced knowledge is preferred.

• Advanced proficiency in Microsoft Excel, Outlook, and Word.

• Ability to maintain confidentiality concerning patient-sensitive information.

• Must be able to sit regularly and occasionally lift or move up to 10 pounds.

🏝️ Benefits

• Full-time employment opportunities.

• Remote work options available.

• Equal employment opportunity commitment.

• Reasonable accommodations for individuals with disabilities.

• Human oversight in AI-assisted recruiting and employment decisions.