Patient Access Specialist

Spectraforce Technologies, Inc.; Raleigh (NC); Remote; USD 25,000 - 36,000; Part time

Job summary

Spectraforce Technologies, Inc. seeks a Patient Access Specialist for a 3-month remote assignment in the US. Key duties include patient inquiries, billing and claims support, prior authorizations, and coordination of benefits.

Training occurs Monday-Friday EST, with a requirement for a dual monitor setup. Ideal candidates have strong communication, organizational, and Excel/Office skills, plus familiarity with medical billing and claims processes.

Qualifications

• High school diploma or GED required; two-year associate degree or equivalent experience preferred.
• Four+ years of related and progressively responsible experience; degree can substitute for experience.
• Experience in medical billing, coding, customer service or similar vocations.

Responsibilities

• Provide advanced services to patients, providers and caregivers, including billing and coding support.
• Assist with claims processing, tracking and submission.
• Assist with prior authorizations and coordination of benefits.
• Verify benefits and respond to patient inquiries; maintain confidentiality.
• Escalate complaints and ensure timely, accurate responses.
• Act as regional expert on payer trends and reimbursement issues.

Skills

Effective communication

Relationship building

Interpersonal skills

Mathematical skills

Analytical skills

Organizational skills

Accounting basics

Pharmacy operations

Medical claims

Customer service

MS Office proficiency

Education

High school diploma or GED

Associate degree or equivalent experience

Technical/vocational training

Tools

Microsoft Excel

Outlook

Word

Job description

Patient Access Specilist

Location: Anywhere in US (Remote)

Duration: 3 month assignment

Shift timings: 8:00 AM - 8:00 PM EST

• 1st shift- 8:00am - 4:30pm
• 2nd shift- 11:30am - 8pm

Note : candidate should be fine for both shfts.

Hours during training: Monday - Friday, 8:30 am-5:30pm EST, Note : candidate should have their own equipment; will need a dual screen

Description:

Under the general supervision of an Operations Manager, the Customer 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:

1. Provides advanced services to patients, providers and caregivers. Services could include but not limited to:
   1. a. Billing and coding support
   2. b. Claims assistance, tracking and submission
   3. c. Prior authorization assistance and tracking
   4. d. Coordination of benefits
   5. e. Benefit verification result call
   6. f. Welcome calls
   7. g. Advanced alternate coverage research
   8. h. Appeals/Denials
   9. i. Intakes and reports adverse events as directed.
2. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
3. 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.).
4. Processes any necessary correspondence.
5. Coordinates with internal and external service providers to ensure services are performed in accordance with program policy and within expected service level agreements (SLA).
6. Maintains confidentiality in regards to all patient sensitive information.
7. 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.
8. Required to be self-motivated, working from a queue (phone or system). Expected to perform work in accordance with defined standard operating procedures. Management will monitor queues and provide active feedback as required.
9. Performs related duties as assigned, could include well defined services generally performed by other program representatives (e.g. benefit verifications, PAP determinations).

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

High school diploma or GED required. Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, customer service or similar vocations generally obtained through completion of a two-year associate's degree program, technical vocational training, or equivalent combination of experience and education. Four years (4) + years directly related and progressively responsible experience required. A two-year degree can be used in lieu of 2 years of the experience requirement, a four-year degree in lieu of 4 years of experience.

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

1. Ability to communicate effectively both orally and in writing.
2. Ability to build productive internal/external working relationships.
3. Advanced interpersonal skills.
4. Strong mathematical skills.
5. Basic analytical skills.
6. Advanced organizational skills and attention to detail.
7. General knowledge of accounting principles, pharmacy operations, and medical claims.
8. Acceptable use of medical industry vernacular.
9. General knowledge of health care billing preferred.
10. Ability to proficiently use Microsoft Excel, Outlook and Word.
11. Developing professional expertise; applies company policies and procedures to resolve a variety of issues.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an associate encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions: The noise level in the work environment is consistent with an office setting.

PHYSICAL AND MENTAL REQUIREMENTS:

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

1. Sedentary physical activity requiring reaching, sifting, lifting, finger dexterity, grasping, feeling, repetitive motions, talking and hearing.
2. Visual requirement is for close vision, distance vision, peripheral vision and ability to adjust focus.
3. 75% or more time is spent looking directly at a computer.
4. Ability to deal with stressful situations as they arise

CPRA:

The Company is committed to complying with the California Privacy Rights Act ("CPRA") effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting [e-mail]