Senior Patient Access Representative

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

📋 Description

• Oversee daily operations for the Benefits Verification and Prior Authorization team.

• Delegate tasks, monitor workflow queues, manage coverage, follow up on productivity, and assist staff with inquiries.

• Conduct both routine and intricate audits of benefit investigations, prior authorization requests, ongoing authorizations, approvals, denials, and related documentation.

• Mentor team members based on audit outcomes and provide timely feedback.

• Facilitate onboarding and continuous training initiatives.

• Identify persistent knowledge gaps or process deficiencies for leadership review.

• Act as the primary escalation point for complex or urgent Benefits Verification and Prior Authorization matters.

• Investigate payer requirements and collaborate on resolutions with Admissions leadership, Audit, Accounts Receivable, clinical teams, and other stakeholders.

• Monitor audit outcomes, turnaround times, work quality, trends, and unresolved issues.

• Offer updates and recommendations to the Admissions Senior Manager.

• Assist in process enhancements, standard operating procedures, policy revisions, and preparations for new therapies or payer modifications.

• Undertake additional duties or projects as assigned.

⛳️ Requirements

• A high school diploma or equivalent from an accredited institution is required.

• At least 3 years of experience in specialty pharmacy, benefits verification, prior authorization, reimbursement, or major medical insurance is preferred.

• Proven ability to manage daily operations, support staff, provide constructive feedback, and reinforce performance standards.

• Comprehensive knowledge of major medical benefits, Medicare, Medicaid, commercial payer guidelines, and policy interpretation.

• Familiarity with prior authorization requirements, authorization date spans, prescription-based unit calculations, and documentation standards.

• Capability to conduct audits objectively, determine root causes and reimbursement risks, and communicate clear corrective measures.

• Excellent organizational, analytical, written, and verbal communication skills.

• Ability to prioritize competing tasks in a fast-paced environment and handle urgent patient or payer escalations.

• Must be highly detail-oriented and capable of managing protected health information in compliance with HIPAA regulations.

🏝️ Benefits

• Medical Coverage

• Dental Coverage

• Vision Coverage

• 401(k) with employer match

• Accident and Critical Illness coverage

• Company-paid life insurance options

• Generous PTO

• Paid holidays

• Floating holidays

• Tuition reimbursement program