Patient Access Specialist

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

📋 Description

• Oversee a case load for a designated program.

• Input and assess new patient cases in the system database.

• Maintain consistent communication with physicians’ offices and their personnel.

• Keep precise and updated records in the Salesforce platform for client reporting.

• Carry out the patient access procedure in accordance with program SOPs, which includes evaluating clinical data and notes to determine medical necessity.

• Analyze insurance policies to establish medical necessity criteria for medical devices and procedures.

• Conduct benefits verification and payer discovery.

• Process prior authorization, pre-service review, and both pre- and post-service appeals.

• Ensure that appeal-support documents are accurate, consistent, up-to-date, and compliant with SOPs, guidelines, and regulations.

• Adhere to regulatory and company policies.

• Achieve program KPIs assessed on a daily, weekly, and monthly basis.

⛳️ Requirements

• High school diploma or equivalent; Associate’s degree is preferred.

• At least 2 years of experience in a healthcare environment, ideally in authorization or billing.

• Familiarity with medical terminology and insurance processes.

• Strong communication and organizational abilities.

• Capability to work independently and manage multiple responsibilities.

🏝️ Benefits

• Medical/Dental/Vision Insurance

• Company-paid Life Insurance

• Healthcare Flexible Spending Account (FSA)

• Employee Assistance Program (EAP)

• Generous Paid Time Off (PTO) Program

• Paid holidays (federal & floating)

• 401(k) Plan with company match

• Employee recognition programs

• Wellness/volunteering/perfect attendance incentives

• Employee Referral Program

• Professional development opportunities

• Internal training programs