Patient Access Specialist

PRIA Healthcare Management LLC; Farmington (CT); On-site; USD 30,000 - 39,000; Full time

Benefits offered by this job

Medical/Dental/Vision Insurance

401(k) Plan with company match

Paid Time Off (PTO)

Paid holidays (federal & floating)

Employee Assistance Program (EAP)

Professional development opportunities

Internal training programs

Job summary

PRIA Healthcare Management LLC is seeking a Patient Access Specialist to support reimbursement and patient access for technologies and procedures. The role involves benefits verification, prior authorizations, and appeals across physicians, billing staff, hospitals, and ambulatory centers.

You will manage case loads, perform data entry in system databases, and maintain Salesforce records for reporting. The position emphasizes accurate documentation and adherence to SOPs as part of the patient

Qualifications

• 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.

Responsibilities

• Manage a case load for an assigned program.
• Data entry and review of new patient cases into system database.
• Communicate with physician’s office and their staff regularly.
• Maintain accurate and up-to-date records within the Salesforce platform to ensure accurate reporting to clients.
• Complete full patient access process as outlined by program SOP including but not limited to: analyze medical necessity criteria per payer policy.
• Review multiple insurance policies to define medical necessity criteria to support device/procedure(s).
• Benefits verification and payer discovery.
• Prior Authorization / pre-service review submissions, pre and post service appeal submissions.
• Ensure all documents developed to support an appeal are accurate, consistent, up to date, and in compliance with SOPs.

Skills

Healthcare experience

Authorization/billing knowledge

Communication skills

Independent work

Organizational skills

Education

High school diploma

Associate’s degree preferred

Tools

Salesforce

Data entry

Job description

The Patient Access Specialist is responsible for supporting our client’s reimbursement needs to facilitate patient access to their technologies and procedures. This position will support a variety of key economic stakeholders including client company representatives and their customers including physicians, billing and coding personnel, hospitals, and ambulatory surgical centers. This position will be accountable to serve as a resource in patient access services including, benefits verification, prior authorization, pre-service appeals and post service claims appeals.

Key Responsibilities:

• -Manage a case load for an assigned program
• -Data entry and review of new patient cases into system database
• -Communicate with physician’s office and their staff regularly
• -Maintain accurate and up-to-date records within the salesforce platform to ensure accurate reporting to clients.
• -Complete full patient access process as outlined by program SOP including but not limited to:
• With Assistance from the Executive Lead, Analyze and interpret patient clinical data, clinical notes and files to determine medical necessity criteria is met specific to each payer policy
• With assistance from the Executive Lead, Review multiple insurance policies to define medical necessity criteria to support medical device/procedure(s)
• Benefits verification and payer discovery
• Prior Authoriation/ Pre- service review submissions, pre and post service appeal submissions
• Ensure all documents developed to support an appeal are accurate, consistent, up to date, and in compliance with applicable Standard Operating Procedures, guidelines, and regulations.

Ensure compliance with all regulatory and company policies.

KPI's:

• Established based on the program complexity and align with program success
• -Once KPIs are established they are measured daily, weekly and monthly

Qualifications:

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

Our Comprehensive Benefits package includes:

• -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