Case Manager, Patient Access & Reimbursement

Ashfield Healthcare, LLC; Yardley (WA); Hybrid; USD 38,000 - 70,000; Full time

Benefits offered by this job

Competitive pay

Comprehensive benefits

401(k) with company match

Paid time off

Company holidays

Career advancement

Great Place to Work award

Job summary

Inizio Engage is seeking a Patient Access Specialist to manage assigned patient cases from referral through therapy initiation, ensuring timely and compliant progression.

You will conduct benefits investigations, determine coverage and patient financial responsibility, manage prior authorizations and appeals, and assist patients with enrollment in financial assistance programs while coordinating with payers, providers, and internal teams.

Qualifications

• Bachelor's degree or equivalent experience preferred.
• Experience in patient access, HUB services, reimbursement support, specialty pharmacy, or healthcare case management preferred.
• Working knowledge of benefits investigation, prior authorization, appeals, and patient assistance programs.
• Strong communication and interpersonal skills with a patient-focused approach.

Responsibilities

• Manage assigned patient cases from referral through therapy initiation, ensuring timely, accurate, and compliant case progression.
• Conduct benefits investigations electronically or by calling the insurance company to determine coverage information, prior authorization requirements, and patient financial responsibility.
• Manage the prior authorization and appeals process, including obtaining plan-specific criteria and requirements, initiating, submitting, and tracking requests, and following up with plans, patients, and HCPs as needed to ensure timely outcomes.
• Identify and facilitate patient enrollment in financial assistance programs, including copay and patient assistance programs.
• Support communications with patients, healthcare providers, payers, and specialty pharmacies as needed.
• Provide education on insurance coverage, access pathways, and next steps in the treatment journey when needed.
• Collaborate with internal teams and external partners to ensure timely therapy initiation and adherence to service level agreements.
• Document all case activity accurately within HUB systems in compliance with SOPs and regulatory requirements.
• Monitor case progress and elevate complex reimbursement issues as needed.
• Response to incoming calls from patients/caregivers and prescriber’s offices and addressing or routing calls as needed.
• Support leadership with tracking and resolving escalations.
• Support quality initiatives, audits, and continuous process improvement efforts.
• Ensure compliance with HIPAA, privacy, and regulatory standards at all times.

Skills

Strong communication

Interpersonal skills

CRM systems

Microsoft Office

Education

Bachelor's degree or equivalent experience

Tools

CRM systems

Microsoft Office

Job description

Inizio Engage is seeking a Patient Access Specialist to manage assigned patient cases from referral through therapy initiation, ensuring timely and compliant progression.

You will conduct benefits investigations, determine coverage and patient financial responsibility, manage prior authorizations and appeals, and assist patients with enrollment in financial assistance programs while coordinating with payers, providers, and internal teams.