Patient Access Specialist

Paragon Healthcare is a leading provider of infusion services with over 70 locations throughout the US. We specialize in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting.

We are an award-winning company and have been on the Inc. 5000 fast growing companies in America for 8 consecutive years and have been certified as a Great Place to Work.

Under general direction of the Patient Access Manager, or Supervisor, Patient Access Specialist performs tasks related to overall patient referral processing and workflow through operations including patient calls, chart creation, insurance verifications and submission of prior authorizations, pre-determinations, and appeals. The Patient Access Specialist provides optimal customer service, interacting and collaborating as a patient advocate expert to internal and external customers to reduce and eliminate any disruptions, or delays to medical treatment. The Patient Access Specialist independently manages referrals assigned with a sense of urgency maintaining quality and accuracy. The Patient Access Specialist analyzes payer trends, is a subject matter expert in payer requirements, performs root cause analysis, displays advanced knowledge with contract language, ability to work through ambiguity, and effectively communicates to Management any potential impact to the business.

Our motto is simple – People, Purpose, Passion. We care about providing the highest quality healthcare solutions.

• People – for over 15 years, we have specialized in life-saving infusible and injectable therapies used to treat people with a wide range of diseases and conditions.
• Purpose – Our heart is to service people by providing excellent healthcare services focused on improving their quality of life so they can reach their personal goals.
• Passion – We do this by taking the time to connect with each patient in order to best understand their specific needs and then empower them on their health journey.

Responsibilities:

• Advanced knowledge of HCPCS, NDC, CPT, and ICD-10 coding for referral management.
• Ability to read and interpret payer contracts, and payer policies to effectively manage referrals and mitigate risk of accounts receivable.
• Ability to review and interpret clinical records to ensure patient meets medical policy guidelines for coverage.
• Ability to accurately verify eligibility and benefits for medical and pharmacy payers through multiple methods.
• Ability to initiate pre-determination, prior authorizations, and appeals for denials based on payer policy.
• Ability to process pharmacy benefit manager claims.
• Ability to perform research and analysis of patient account issues and strives to resolve problems timely and accurately.
• Ability to document medical records in operating system(s) in a clear and concise manner.
• Analyze and prioritize workloads based on department inflows to meet company expectations.
• Achieve daily, weekly, and monthly expectations around productivity, quality, and other key metrics pertaining to the patient access specialist specific role.
• Responsible for responding timely and accurately supporting internal and external customers.
• Provide exceptional customer service to patients, internal and external customers.
• Works on problems of diverse scope where analysis of data requires evaluation of identifiable factors. Demonstrates good judgment in selecting methods and techniques for obtaining solutions. Networks with internal and external personnel in own area of expertise. Ability to facilitate through ambiguity.
• Conforms to, supports, and enforces all company policy and procedures.
• Maintains confidentiality regarding patient account status and the financial affairs of clinic/corporation.
• Performs related duties as assigned.

About You:

• High School Diploma or equivalent (GED) required.
• Pharmacy tech license, medical coding, or revenue cycle management certification preferred.
• Major medical and pharmacy benefits management experience.
• Knowledge and experience of procedures for benefit eligibility, pre-determination, prior authorization, and denial management.
• Understanding of payer medical policy guidelines, and utilization of these guidelines to manage prior authorizations timely and effectively.
• Biologics, Ig, Acute, and/or Chronic therapies experience required.
• A minimum of 3 years’ experience in the medical field (preferably home infusion) with a working knowledge of managed care, commercial insurance, Medicare, reimbursement.

Salary Range:

We take pride in ensuring we compensate our employees fairly and equitably. We provide a range and actual starting pay may be based on several factors including but not limited to, market rate, qualifications, internal compensation, candidate location, and budgetary constraints. This number does not necessarily reflect your total compensation but is a range for your base salary.

• $17 - $24/hour

Benefits:

• Eligible for Bonus Incentive Opportunity after the 90-day probationary period - Up to 10% of your base pay, paid quarterly
• Health Insurance with Dental and Vision Plans available
• Paid Group Term Life and Disability Insurance for all full-time employees
• 401(k) Plan available with up to a 4% company match
• Paid Time Off (PTO) in addition to paid company holidays

IND123L

Salary : $17 - $24