Patient Access Specialist – Director

Job not on LinkedIn

November 23

🦌 Connecticut – Remote

Although this job is listed in Connecticut, this company may be open to hiring remote in other states.

⏰ Full Time

🔴 Lead

👔 Director

Apply Now

Receive Emails with Similar Jobs

PRIAevents

WebsiteLinkedInAll Job Openings

B2B • Education • Events

PRIAevents is a company that organizes events and conferences, featuring speakers from various fields. They provide opportunities for career growth and actively engage in sharing knowledge through their events. Their platform aims to enhance the experience of attendees and speakers alike, ensuring informative and valuable interactions.

2 - 10 employees

🤝 B2B

📚 Education

📋 Description

• Participation on weekly program calls as needed. • Train and mentor new patient access specialists. • Audit a select number of cases per program as directed by the Director/Manager, Patient Access. • Manage a case load for an assigned program. • Data entry and review of new patient cases into system database. • Serve as a primary point of contact for providers and patients seeking insurance coverage assistance. • Communicate with physician’s office and their staff regularly. • Maintain accurate and up-to-date records within the salesforce platform to ensure accurate reporting to clients. • Complete full patient access process as outlined by program SOP including but not limited to: • Analyze and interpret patient clinical data, clinical notes and files to determine medical necessity criteria is met specific to each payer policy • Review multiple insurance policies to define medical necessity criteria to support medical device/procedure(s) • Conduct case-related research (e.g., payer coverage policies, self-funded plans, state and federal regulations). • Benefits verification • Prior Authoriation/ Pre- service review submissions, pre and post service appeal submissions • Ensure all documents developed to support an appeal are accurate, consistent, up to date, and in compliance with applicable Standard Operating Procedures, guidelines, and regulations. • Maintain strong professionalism, ethics, and compliance with all applicable laws and policies • Ensure compliance with all regulatory and company policies.

🎯 Requirements

• College degree preferred but will substitute for applicable work experience • Minimum of 4-5 years experience in a healthcare setting, preferably in authorization or billing. • In-depth knowledge of insurance processes, medical terminology, and healthcare regulations. • Preferred experience with supporting mental health treatment programs, specifically those related to Major Depressive Disorder (MDD) • Knowledge of Medicaid, Medicare, and commercial payer requirements, including prior authorization and appeals processes. • Strong problem-solving skills. • Ability to remain patient, empathetic, and composed throughout long, time-intensive interactions with individuals experiencing mental health challenges • Strong analytical, and problem-solving skills. • Excellent communication and interpersonal skills.

🏖️ Benefits

• Health insurance • Professional development opportunities