Patient Access Specialist

🔥 1 hour ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $26 - $32 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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PRIA Healthcare

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2012

🏥 Healthcare

💼 Consulting

🤝 B2B

💰 Private equity on 2022-02

Healthcare • Consulting • B2B

PRIA Healthcare is a specialized consulting firm that helps medical device and healthcare technology companies navigate U. S. reimbursement, regulatory, and market access pathways to enable commercialization. PRIA offers strategic reimbursement solutions, health economics and outcomes research, evidence generation, payer and stakeholder engagement, patient access platforms and services (including reimbursement hotlines and clinical trial reimbursement), regulatory strategy and global marketing submissions, and quality management and post-market compliance support. The firm emphasizes tailored, pragmatic execution plans and states it has served 300+ clients, implemented 75+ patient access programs, and approved 40,000+ patients. PRIA is headquartered in Farmington, CT.

📋 Description

• Manage a case load for an assigned program. • Enter and review new patient cases in the system database. • Communicate regularly with physicians’ offices and their staff. • Maintain accurate and up-to-date records in the Salesforce platform for client reporting. • Complete the patient access process according to program SOPs, including analyzing clinical data and notes to assess medical necessity. • Review insurance policies to define medical necessity criteria for medical devices and procedures. • Perform benefits verification and payer discovery. • Submit prior authorization, pre-service review, and pre- and post-service appeals. • Ensure appeal-support documents are accurate, consistent, current, and compliant with SOPs, guidelines, and regulations. • Ensure compliance with regulatory and company policies. • Meet program KPIs measured daily, weekly, and monthly.

🎯 Requirements

• High school diploma or equivalent; Associate’s degree preferred. • Minimum of 2 years of experience in a healthcare setting, preferably in authorization or billing. • Understanding of medical terminology and insurance processes. • Excellent communication and organizational skills. • Ability to work independently and handle multiple tasks.

🏖️ Benefits

• Medical/Dental/Vision Insurance • Company-paid Life Insurance • Healthcare Flexible Spending Account (FSA) • Employee Assistance Program (EAP) • Generous Paid Time Off (PTO) Program • Paid holidays (federal & floating) • 401(k) Plan with company match • Employee recognition programs • Wellness/volunteering/perfect attendance incentives • Employee Referral Program • Professional development opportunities • Internal training programs

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