Great opportunity to work with an award-winning healthcare company based in Dallas, TX with locations throughout Texas, Tennessee, Colorado, Alabama, Oklahoma, Georgia, and California. This position is FULL-TIME in our Plano office.

The Patient Access Specialist performs tasks related to overall patient referral processing & operations including patient calls, chart creation, insurance verifications & authorizations, and copay assistance. This has a direct impact to the patients access to infusion therapies serviced by Paragon.

Education/Experience:

• High School Diploma or equivalent (GED) required.
• Excellent interpersonal, communication and organizational skills required.
• Ability to prioritize, problem solve, and multitask is required.
• A minimum of 1-2 years’ experience in the medical field (preferably home infusion) with a working knowledge of managed care, commercial insurance, Medicare reimbursement, and verification processes preferred.

Major Responsibilities:

• Responsible for delivering exceptional service to patients, providers, and team members, including open channels of communication, prompt response to inquiries and requests, and timely, accurate follow up of missing documentations.
• Effectively communicates and escalates issues to the appropriate team members for patient-centric solutions.
• Maintains daily tasking work queue, quality assurance, and established productivity levels with minimal errors.
• Obtains and documents prior authorizations as required by the payer, including procurement of needed clinical documentation by collaborating with the Patient Access team and clinical teams.
• Verifies patient specific insurance benefits and documents information accurately in patient charts including drug coverage, administration coverage, cost share, and access / provider options according to program specific SOPs.
• Reviews patient accounts to determine copay assistance eligibility. Proactively provide enrollment to manufacturer copay cards and financial grant programs through education, obtaining forms, and submission when eligible.
• Aid with reimbursement inquiry requests, including insurance benefit verification, prior authorization, denials and appeals, and other reimbursement issues.
• Identifies any restrictions and details on how to expedite patient access.
• Performs research and analysis of patient account issues and strives to resolve problems timely and accurately.

Work Standards

• Able to work in a team setting, requiring cross-training of multiple functions.
• Able to prioritize, have excellent customer service and organization skills with attention to detail, and to work effectively in stressful situations.
• Understands and adheres to all external accreditation review standards, applicable state, local, and Federal laws and/or regulations, including maintaining patient confidentiality through abiding by HIPAA laws/regulations.
• Understands and adheres to all company policies and procedures.
• Able to work under strict guidelines, competing priorities, and immediate requests.
• Establishes and maintains positive working relationships with internal and external customers, as well as all company employees.
• Displays a neat, clean, and professional appearance at all times.
• Handles customer/patient complaints in a fair and empathetic manner.

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Education

• High School or better