Patient Access Consultant

🔥 3 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CareMetx, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

💼 Consulting

🏥 Healthcare

⚕️ Healthcare Insurance

Consulting • Healthcare • Healthcare Insurance

CareMetx, LLC is a company that specializes in transforming patient access to specialty therapeutics by reducing the time to therapy. They offer a digital Hub service that addresses emotional, financial, and clinical barriers for patients, aiming to improve treatment timelines and ongoing therapy use. CareMetx provides high-touch support and utilizes advanced technology to offer solutions for access, affordability, and adherence, benefiting both patients and healthcare providers. They partner with specialty pharmaceutical brands, healthcare providers, and hospital systems to enhance patient outcomes.

📋 Description

• Perform reimbursement activities, claim submission and status tracking, collection activity, appeals, patient assistance, and copay assistance • Provide billing and coding support, claims assistance, prior authorization assistance, coordination of benefits, benefit verification calls, welcome calls, and alternate coverage research • Handle appeals and denials, inbound phone queue inquiries, support-program determinations, pharmacy triage and coordination, order processing, follow-up activities, intakes, adverse-event reporting as directed, and non-clinical adherence services • Engage manufacturer representatives regarding payer profiles, reimbursement trends, and office-specific issues • Coordinate services with field reimbursement teams and sales representatives • Provide customer service to internal and external customers and resolve or escalate requests and complaints • Analyze, report, resolve, and communicate reimbursement trends and delays • Process correspondence and coordinate with internal and external service providers according to program policies and service-level agreements • Provide support to internal associates and handle initial customer escalations • Verify transactions and compliance with organizational and departmental policies and procedures; suggest changes and solutions • Independently resolve complex accounts with minimal supervision • Maintain confidentiality of patient-sensitive information • Analyze complex issues, exercise judgment in selecting methods and evaluation criteria, and network with contacts outside the area of expertise • Determine methods and procedures for new or special assignments • Perform related duties and special projects as assigned

🎯 Requirements

• High school diploma or GED required • Broad training in business administration, accounting, computer sciences, medical billing and coding, customer service, or similar vocations through a two-year associate’s degree program, technical vocational training, or equivalent combination of experience and education • Five (5) or more years directly related and progressively responsible experience required • A two-year degree can be used in lieu of 2 years of the experience requirement • A four-year degree can be used in lieu of 4 years of the experience requirement • Four-year degree preferred • Ability to communicate effectively both orally and in writing • Ability to build productive internal/external working relationships • Advanced interpersonal skills • Strong mathematical skills • Basic analytical skills • Advanced organizational skills and attention to detail • Extensive knowledge of pharmacy operations and medical claims • Excellent use of medical industry vernacular • General knowledge of health care billing required; advanced knowledge preferred • Advanced use of Microsoft Excel, Outlook, and Word • Ability to maintain confidentiality regarding patient-sensitive information • Must sit regularly and occasionally lift or move up to 10 pounds

🏖️ Benefits

• Full-time employment • Remote work arrangement • Equal employment opportunity • Reasonable accommodations for individuals with disabilities • Human review of AI-assisted recruiting and employment decisions