Patient Access Specialist

📋 Description

• • Lead and manage day-to-day activities of a patient and healthcare provider support team within a contact center environment, handling requests via phone, fax, chat, and email.
• • Serve as a subject matter expert for patient support programs, providing timely and accurate responses to complex questions regarding medication access, reimbursement, and affordability pathways.
• • Conduct quality call monitoring for team members and provide constructive feedback to improve performance and adherence to program scripts and guidelines.
• • Ensure all patient support requests are accurately documented and tracked within the Case Management system, maintaining compliance with internal protocols and regulatory standards.
• • Coordinate end-to-end case management for patients, including benefit investigations, prior authorizations, appeals, and referrals to appropriate support programs.
• • Educate healthcare providers and patients on available patient support services, eligibility criteria, and the referral process to facilitate timely case resolution.
• • Communicate effectively with payers, pharmacies, third-party administrators, and internal departments to resolve access barriers and secure medication coverage for patients.
• • Perform in-depth research into patient medication coverage, including insurance benefits, formulary restrictions, and financial assistance programs.
• • Escalate complex or unresolved cases to appropriate program leadership while ensuring timely follow-up and resolution.
• • Compile and disseminate monthly program metrics and performance data to management, supporting data-driven decision-making and operational improvements.
• • Maintain strict adherence to HIPAA and all patient privacy regulations, ensuring confidentiality and compliance across all patient interactions.
• • Demonstrate leadership by modeling corporate values including quality, integrity, innovation, accountability, collaboration, and ethical conduct.
• • Foster a collaborative team environment by promoting teamwork, active listening, and knowledge sharing among team members.
• • Adapt quickly to evolving program requirements, regulatory changes, and operational priorities while maintaining high standards of productivity and accuracy.
• • Exhibit exceptional interpersonal and customer service skills when interacting with patients, providers, and internal stakeholders under high-volume conditions.
• • Manage competing priorities effectively, maintaining a sense of urgency and strong organizational skills to meet strict deadlines and performance targets.
• • Demonstrate creative problem-solving abilities to identify and implement process improvements that enhance patient access and team efficiency.
• • Maintain compliance with all program business rules, standard operating procedures, and corporate guidelines at all times.