Patient Access Representative II - Accredo

Schedule: Full-time

Job ID: REQ20005560

POSITION SUMMARY

The Patient Access Representative II is dedicated to meeting the expectations and requirements of internal
and external customers by obtaining required patient, payer and physician documentation, verifying
insurance benefits, completing shipments and documenting all transactions in the system. As necessary, the
Patient Access Representative II may also perform quality audits and negotiate pricing. This position requires
highly developed interpersonal and communication skills to successfully interact with patients, pharma,
physicians and payers to complete the verification process.

ESSENTIAL FUNCTIONS

• Performs all aspects of electronic claims process and rejection resolution.
• Ensures accounts requiring authorizations and re-authorizations are identified, secured, and updated in RX Home prior to each shipment. Notifies as appropriate if authorization cannot be obtained.
• Contacts benefit providers to gather policy benefits/limitations to ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
• Handles inbound client calls and written correspondence regarding patient eligibility.
• Provides inbound phone call support to the prior authorization team giving personal attention to the resolution of customer issues having to do with the status of letter requests or physician review process.
• Supports cross-functional departments in resolution of eligibility issues (claims, contact center, account management, service delivery, etc.)
• Negotiates pricing for non-contracted payers and authorizes patient services and ensures proper pricing is indicated in RxHome. Works referrals.
• Completes other projects and additional duties as assigned.

QUALIFICATIONS

• High school diploma or GED required, bachelor’s degree preferred
• 2-3 years of relevant working experience to include one year of health care experience with medical insurance knowledge and terminology
• Intermediate data entry skills and working knowledge of Microsoft Office
• Extensive knowledge of ESI products and services a must; Experience training and coaching less experienced staff with patience to explain details and processes repeatedly; Excellent phone presentation and communication skills; Demonstrated ability to handle challenging customers in a professional manner, ability to adapt in a dynamic work environment and make decisions with minimal supervision; Advanced problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions

ABOUT THE DEPARTMENT

A leading provider of specialty pharmacy services, Accredo improves care for patients through behavioral and clinical expertise.

Accredo offers a broad range of healthcare products and services for individuals with chronic health conditions, such as growth hormone deficiencies, hepatitis C, hemophilia, oncology, multiple sclerosis and rheumatoid arthritis. It also provides comprehensive patient management services, including clinical care management programs, counseling, education, outcomes measurement, social services and reimbursement services.