Patient Access Specialist in North Chicago, IL

Years of experience/education and/or certifications required:

• High school diploma or equivalent required
• A minimum of 1-3 years’ experience within a call center; healthcare provider, PBM, Specialty Pharmacy or Retail/Mail Order Pharmacy setting, strong core insurance
• Knowledge of online benefit verification systems or similar experience strongly required

What are the top 3-5 skills requirements should this person have?

• Insurance Knowledge – Nice to have
• Customer service or patient knowledge
• Financial knowledge

Mon – Fri Flexibility to work 8hr shift between 7AM-7Pm Central standard time, Yes OT up to 8hrs mandatory

Patient Access Specialist

Purpose:

• Describe the primary goals, objectives or functions or outputs of this position.
• The Patient Access Specialist (PAS) provides support to those patients who are uninsured, underinsured, who have limited benefit coverage and or who have high out of pocket prescription and medical expenses which may qualify them into the Client Patient Assistance Program (PAP).
• The PAS provides high quality customer service to both patient and health care providers (HCPs) for specialty prescription medication provided by the Client Patient Assistance Program.
• The PAS will coordinate review of all application documents, conduct insurance investigations when applicable, assess patient’s financial information and provide an outcome status to patients and HCPs.

Responsibilities:

• List up to 10 main responsibilities for the job. Include information about the accountability and scope.
• Investigate patient’s insurance coverage when applicable by conducting payer calls, utilizing insurance Client and web tools
• Review financial documents for completion to assist with assessing for program eligibility
• Provide subject matter expertise on medical and prescription insurance coverage, medication prior authorization process, and alternate financial assistance opportunities for patients
• Apply Client Patient Assistance Program standards to each case to render the appropriate decision of approval or denial into the program
• Conduct the outreach process to obtain missing information that is required to complete an application assessment
• Ensure all patient cases are documented in the Customer Relationship Management System (CRM) in accordance with all business rules and policies
• Receive and handle incoming calls from patient’s and HCPs
• Complete renewal and year end recertification’s process as determined by the Client Patient Assistance Program
• Readily assists on special project within job scope to improve reimbursement optimization when requested by management

Qualifications:

• List required and preferred qualifications (up to 10). Include education, skills and experience.
• High school diploma or equivalent required. College or a 2-year Associate Degree is preferred
• A minimum of 1-3 years’ experience within a call center; healthcare provider, PBM, Specialty Pharmacy or Retail/Mail Order Pharmacy setting, strong core insurance (Medical and Pharmacy Benefit) knowledge preferred
• Knowledge of online benefit verification systems or similar experience strongly required
• High quality customer service skills
• Strong attention to detail and with the ability to multi-task required; strong analytical skills preferred
• Ability to express ideas clearly in both written and oral communications

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