Access Manager – Healthcare Claims, PAs, Reimbursement & Appeals

🔥 20 minutes ago

🇺🇸 United States – Remote

💵 $36 - $42 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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PRO-spectus

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2008

🏥 Healthcare

💊 Pharmaceuticals

💼 Consulting

💰 Private equity on 2024-05

Healthcare • Pharmaceuticals • Consulting

PRO-spectus is a patient access and market access services provider that helps pharmaceutical, biotech, medical device, and diagnostic manufacturers overcome reimbursement, coding, and policy barriers to getting products to patients. The firm offers patient support services, reimbursement support, policy strategy, affordability and adherence programs, and leverages technology alongside market-access expertise to optimize access across the healthcare landscape. PRO-spectus positions itself as a collaborative, B2B partner to manufacturers seeking to expand coverage and patient access to specialized therapies and diagnostics.

📋 Description

• Navigate the patient access process from benefit verification through treatment initiation and resolution of claims or reimbursement issues • Identify and address barriers to care, including coverage, authorization, and reimbursement barriers • Manage end-to-end case activities through insurance verification and authorization processes • Establish coverage approval, secure appropriate payment channels, and coordinate copay or foundation assistance • Prioritize insurance approval timelines, patient treatment schedules, and stakeholder communications • Serve as the single point of contact among internal and external teams, clients, providers, payors, facilities, and patients • Support multiple client programs while ensuring operational oversight and consistent quality service • Provide relationship management and education to physicians, office staff, payors, patients, and clients • Collaborate with the FRM Team and other Patient Services functions to coordinate patient access activities

🎯 Requirements

• Advanced knowledge and experience in a healthcare setting • Strong understanding of biologic and specialty pharmaceutical markets, reimbursement dynamics, and patient access challenges across diverse payor landscapes • 2–4 years of experience in a pharmacy, healthcare setting, and/or insurance background with a customer service focus • Proficiency in prior authorization and reimbursement scenarios • Skill in verifying patient benefits and analyzing clinical documentation against payor/plan coverage policies and criteria • Understanding of insurance verification, prior authorization, and appeals processes related to coding, coverage, and payment • Strong documentation, reporting, verbal, and written communication skills • Ability to organize, multitask, prioritize work, and manage deliverables within established timelines • Ability to independently manage caseloads and resolve problems • Ability to learn and implement new processes, systems, and protocols • Flexibility to work across Eastern Standard Time to Pacific Standard Time zones • College degree (bachelor’s or associate degree) is preferred

🏖️ Benefits

• Robust medical, dental, and vision plans • Life insurance and disability coverage • Tax-advantaged savings accounts • Employee Assistance Program • Home office benefits • Employee Ownership Program • Paid time off • Paid holidays • Bereavement leave • 401(k) retirement plan with employer matching • Potential eligibility for a performance-based bonus opportunity

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