PRIAevents

Executive

• Lead and manage a team of patient access specialists to achieve departmental goals
• Monitor and analyze data within the salesforce platform to identify areas for improvement and efficiency
• Responsible for teams KPIs
• Train and mentor new patient access specialists
• Audit a select number of cases per program as directed by the Director, Patient Access
• Work closely with other Executive Leads and the Director, Patient Access to improve/enhance operations best practices
• Maintain open communication with each program assigned Strategic Account Manager and work in conjunction with them on, weekly program reviews, calls, frequent questions or concerns regarding the program
• Escalate issues to the program Strategic Account Managers as needed
• 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 and interpret patient clinical data, clinical notes and files to determine medical necessity criteria is met specific to each payer policy
• Review multiple insurance policies to define medical necessity criteria to support medical 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 applicable Standard Operating Procedures, guidelines, and regulations
• Ensure compliance with all regulatory and company policies