Patient Access Specialist

From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

Job Title: Patient Access Specialist

POSITION SUMMARY:


Under the general supervision of the designated manager, the Patient Access Specialist will be providing advanced services to patients, providers, and caregivers on behalf of patients for a specific manufacturer sponsored program or set of programs.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Provides advanced services to patients, providers and caregivers. Services could include but not limited to:
• Billing and coding support.
• Claims assistance, tracking and submission.
• Prior authorization assistance and tracking.
• Coordination of benefits.
• Benefit verification result call.
• Welcome calls.
• Advanced alternate coverage research.
• Appeals/Denials.
• Intakes and reports adverse events as directed.
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Establishes themselves as regional experts regarding payer trends and reports any reimbursement trends/delays to management team (e.g. billing denials, claim denials, pricing errors, payments, etc.).
• Processes any necessary correspondence.
• Coordinates with internal and external service providers to ensure services are performed in accordance with program policy and within expected service level agreements (SLA's).
• Maintains confidentiality in regards to all patient sensitive information.
• Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.
• Required to be self-motivated, working from a queue (phone or system). Expected to perform work in accordance with defined standard perating procedures. Management will monitor queues and provide active feedback as required.
• Performs related duties as assigned, which could include well defined services generally performed by other program representatives (e.g.
• benefit verifications, Patient Assistance Program determinations).
• Applies company policies and procedures to resolve a variety of issues.

Qualifications

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

• High school diploma or GED required.
• Requires a minimum of four (4) years directly related and progressively responsible experience in customer service, medical billing and coding, benefits verification, healthcare, business administration or similar vocations.
• A bachelor's degree is preferred.
• An equivalent combination of education and experience will be considered.

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

• Advanced customer service experience.
• Ability to communicate effectively both orally and in writing.
• Ability to build productive internal/external working relationships.
• Advanced interpersonal skills.
• Basic analytical skills.
• Advanced organizational skills and attention to detail.
• Must be proficient with Microsoft Excel, Outlook and Word.
• General knowledge of the healthcare industry is preferred.

Physical Demands:


The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit.
• The employee must occasionally lift and/or move up to 10 pounds.

Work Environment:


The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Schedule:

• Must be flexible on schedule and hours.

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

Artificial Intelligence in Our Recruiting and Employment Process

CareMetx uses artificial intelligence and automated decision-making technology to support parts of our recruiting, hiring, and employment process, including screening applications, scheduling interviews, and evaluating candidate qualifications. These tools support, not replace, human judgment. A qualified member of our team reviews and makes all final hiring and employment decisions.

CareMetx does not develop or use AI tools with the intent to discriminate against applicants or employees on the basis of race, color, religion, sex, age, sexual orientation, national origin, disability, veteran status, or any other protected characteristic.